OMS

GLOBAL
ORGANIZATIONS
The World Health

Organization
GLOBAL
ORGANIZATIONS
The African Union
The Arab League
The Association of Southeast Asian Nations
The Caribbean Community
The European Union
The International Atomic Energy Agency
The Organization of American States
The Organization of the Petroleum

Exporting Countries
The United Nations
The United Nations Children’s Fund
The World Bank and

the International Monetary Fund
The World Health Organization
The World Trade Organization

GLOBAL
ORGANIZATIONS
The World Health

Organization
G. S. Prentzas
Series Editor
Peggy Kahn
University of Michigan–Flint
Copyright © 2009 by Infobase Publishing

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The World Health Organization / G.S. Prentzas.
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Contents
Introduction: Outbreak! 7
1 Introduction to the
World Health Organization 12
2 The Rise of International Public Health 21
3 WHO at Work 35
4 The UN Millennium Development Goals 51
5 Combating HIV/AIDS,
Malaria, and Tuberculosis 66
6 Preventing and Controlling

Chronic Diseases 81
7 Ensuring Global Health 97
8 Health Care for Everyone 112

Chronology 117
Notes 119
Bibliography 122
Further Reading 126
Picture Credits 129
Index 130
About the Contributors 135
introdUCtion
Outbreak!
In February 2003, a hospital in Hanoi, Vietnam, trans-
ferred a patient to a hospital in Hong Kong, China. The symp-
toms of the patient, Johnny Chen, included fever, weakness, a
dry cough, and respiratory problems. The 46-year-old Ameri-
can businessman’s condition quickly worsened. Within a few
days, health-care workers at the Hong Kong hospital began to
get sick. They had the same symptoms as Chen. The Hanoi
hospital where Chen first sought care reported that a similar
outbreak was racing through its facility. On March 13, Chen
died of an unknown type of pneumonia.
Medical experts first believed that the disease that killed
Chen was a type of bird flu. A month earlier, two people in
Hong Kong had been diagnosed with a rare form of influenza
found in birds. One had died. Scientists had already discovered
7
that humans could sometimes contract flu viruses that afflict

birds. In 1997, a deadly strain of flu that had jumped from birds
to humans infected 18 people in Hong Kong, killing 6.
Medical tests on the patients in the Hong Kong and Hanoi
hospitals showed that the new deadly disease was not caused by
a virus or bacteria associated with bird flu or any other known
type of influenza. Researchers realized that this was a new type
of respiratory disease. They gave it a name: severe acute respi-
ratory syndrome (SARS).
To help doctors diagnose the disease, health officials
quickly identified and distributed a list of the symptoms of
SARS. The disease begins with a high fever (temperature
exceeding 100.4° F [38.0° C]). Other symptoms then occur,
including headache, body aches, and an overall feeling of dis-
comfort. Some patients also have mild respiratory symptoms.
Two to seven days later, many SARS patients develop a dry
cough. Most patients eventually develop pneumonia, the dis-
ease that killed Chen, the first known victim.
Because SARS appeared to spread so quickly and easily,
researchers originally thought that it was passed from person to
person by close contact. They would later agree that an infected
person could transmit SARS through coughing or sneezing.
When a person with SARS coughs or sneezes, she or he sends
thousands of droplets into the air. These droplets can travel
up to 3 feet (0.9 meters). People nearby can be infected if the
droplets land on the mucous membranes of their mouth, nose,
or eyes. People can also become infected with SARS by touch-
ing the droplets and then touching their mouth, nose, or eyes.
Researchers believe that SARS can spread through the air in
other ways yet undiscovered.
With the identification of SARS, the twenty-first century’s
first severe infectious disease had arrived. (An infectious disease
is spread, often person to person, by germs entering the body.)
New SARS cases began to multiply. The disease spread to at
least 15 countries, including Canada, Germany, Singapore, and
Introduction
the United States. In Canada, two Toronto hospitals had to turn

away new patients to help prevent the disease from spreading
further. Health officials in Hong Kong placed an entire apart-
ment building under a quarantine, or medical isolation.
Researchers tried to trace the disease back to its origins.
They determined that a 72-year-old man from Beijing, China,
was one of the first people to contract SARS. He took at least
one plane trip before he began to experience any symptoms.
During that trip, he probably infected as many as 22 pas-
sengers. Many of these people took planes to other countries,
spreading the disease. The movement of these passengers made
it very difficult for health officials to track down the virus and
quarantine those who might pass it on. They discovered that
one passenger had taken seven international flights before
SARS symptoms appeared. He had traveled throughout Europe
and Asia before seeking medical care.
On April 16, 2003, the World Health Organization (WHO)
announced that several laboratories had discovered and con-
firmed the cause of SARS. The respiratory disease is caused
by a coronavirus now known as SARS-associated coronavirus
(SARS-CoV). (The name coronavirus comes from the spikes
that stick out of the virus’s surface; corona is the Latin word
for “crown.”) The virus damages alveoli, the tiny air-filled sacs
in the lungs where oxygen and carbon dioxide are exchanged
between the lungs and the bloodstream. SARS can lead to death
as a result of progressive respiratory failure.
Over the next few months, SARS spread to 30 countries
in Asia, Europe, North America, and South America. In May
2003, more than 180 new infections were being reported
daily. Health officials around the world scrambled to contain
the outbreak. Luckily, SARS proved to be less infectious than
officials first believed. From 2003 to 2005, about 8,500 people
worldwide became sick with SARS. Of these, 812 died. About
20 percent of those infected were health-care workers exposed
to patients with SARS. Among the early victims was Dr. Carlo
10 The World Health Organization
Between November 2002 and July 2003, SARS spread from Guangdong
province in China to some 37 countries around the world, causing world-
wide panic. WHO estimates that SARS caused more than 8,000 infected
cases and more than 700 deaths. In June 2004, recovered SARS patients
and family members (shown above) protested the handling of the outbreak
by the Chinese government, which eventually admitted to underreporting
the number of SARS cases.
Urbani, a WHO doctor in Vietnam. He had examined Johnny

Chen at the hospital in Hanoi and concluded that he was
suffering from some unknown disease. Urbani had been the
person who first brought SARS to the attention of the world’s
health community.
By 2005, WHO reported that SARS had been stamped
out, at least for the time being. Although this century’s first
new infectious disease did not result in a devastating out-
break, it did point out that new microbial threats to human
Introduction 11
health can seemingly arise out of nowhere. In the past 25

years, medical researchers have identified more than 30
new diseases. The SARS outbreak underscored the growing
importance in an increasingly globalized world of improving
international public health cooperation to prevent the spread
of infectious diseases.
In July 2003, Dr. Gro Harlem Brundtland, then the direc-
tor-general of WHO, noted:
SARS is a warning. SARS pushed even the most

advanced public-health systems to the breaking point.
Those protections held, but just barely. Next time, we
may not be so lucky. We have an opportunity now, and
we see the need clearly, to rebuild our public-health
protections. They will be needed for the next global
outbreak, if it is SARS or another new infection.1
1
Introduction to
the World Health
Organization
When World War II ended in 1945, many cities in Europe
and Japan lay in ruins. Battles had been fought in Europe,
Africa, and Asia and at sea. During the six-year global conflict,
warfare had killed more than 50 million soldiers and civilians.
Countless farms, factories, and businesses had been destroyed.
Uncontrolled infectious diseases—such as smallpox, measles,
and tuberculosis—swept through many parts of the world. Mil-
lions of people—many of them now without homes—desper-
ately needed health care to heal their wounds or to treat illnesses
brought on by years of poverty, hunger, and medical neglect.
This was the state of the world in 1946 when the United
Nations (UN) invited public health experts from around the
world to a conference in New York City. (One year earlier, the
nations of the world had joined together to create the UN, an
12
Introduction to the World Health Organization 13
Since 1950, April 7 has been celebrated annually as World Health Day,
marking the founding day of WHO. Every year World Health Day is
used as an opportunity to highlight a priority area of concern to global
health. In 2008, the theme was “protecting health from climate change,”
which focused on helping the global community to be better prepared
to cope with climate-related health challenges worldwide.
international organization devoted to providing peace and

security for all countries.) At the conference, the delegates
worked to establish a global health organization known as the
World Health Organization (WHO).
In drafting a constitution to provide the structure and basic
principles of the new organization, the public-health experts
agreed on a bold goal for WHO. Article I of the constitution
proclaimed that the organization’s mission would be “the
attainment by all peoples of the highest possible level of health.”
The constitution defined health as “not merely the absence of
disease or infirmity” but “a state of complete physical, mental,
and social well-being.”2 This groundbreaking goal grew out of
two fundamental ideas: that every nation has a duty to protect

the health of its citizens and that nations can work together to
prevent the spread of dangerous diseases. WHO’s constitution
came into force on April 7, 1948. The seventh day of April is
now celebrated as World Health Day.
Eradicating Smallpox:
A WHO Success Story
One of the World Health Organization’s proudest achievements

has been the eradication of smallpox. So far, it is the only major
infectious disease ever to have been stamped out.
Smallpox is a deadly and highly contagious disease caused by a
virus. There are two main types of smallpox. Variola major is the far
more serious form. It killed one-third to one-half of all those who
were infected. Variola minor is the much less deadly type, killing
less than 2 percent of people who contracted it. Smallpox left its
mark on survivors. More than two-thirds suffered from permanent,
deep-pitted scars, known as pockmarks, on the face and other
parts of the body. Smallpox also caused blindness in many cases.
The smallpox virus spread easily from one person to another
through face-to-face transmission. When sufferers coughed, they
released huge amounts of virus particles into the air. Clothing and
bedding infected with the virus could also spread smallpox. There
is no effective medical treatment.
Beginning as early as 10,000 b.c., smallpox epidemics swept
across continents. The disease killed millions and affected the
course of human history. Epidemics left countries unable to
defend themselves against their enemies and killed powerful world
leaders. Egyptian pharaoh Ramses V, Incan emperor Huayna Capac,
King Louis XV of France, and other leaders died from smallpox.
U.S. presidents George Washington and Abraham Lincoln and
Soviet premier Joseph Stalin all survived the disease.
Today, WHO has 193 member countries. Its membership

includes every nation in the UN except Liechtenstein, plus two
small, non-UN nations (Niue and the Cook Islands). WHO is
a specialized agency of the United Nations. It governs itself,
but the UN’s Economic and Social Council oversees its activi-
In 1798, British doctor Edward Jenner discovered that injecting

patients with a small amount of the cowpox virus created a natural
immunity to smallpox. Cowpox is in the same virus family as small-
pox, but it is rarely dangerous. Despite the development of Jenner’s
vaccine, hundreds of thousands of people continued to die from
smallpox. Most lived in poor countries or remote areas of wealth-
ier countries. In the early 1950s—a century and a half after the
smallpox vaccination became available—an estimated 50 million
cases of smallpox still occurred worldwide each year. As methodi-
cal smallpox vaccination programs spread, however, cases plunged
to about 10 million a year by the mid-1960s. Smallpox remained
dangerous. It killed about 25 percent of its victims and scarred or
blinded most survivors.
WHO began to coordinate a global smallpox vaccination
program in 1967. The program successfully provided vaccinations
for at-risk populations around the world. The last known natural
case of smallpox occurred in the African country of Somalia in
1977. Since then, the only known smallpox cases were caused by a
1978 accident in an English medical laboratory. One of the two lab
workers infected in that incident died. On May 8, 1980, during its
annual World Health Assembly, WHO declared that smallpox had
been eradicated.
In the event of a future outbreak, small stockpiles of smallpox
vaccine are held in high-security labs in Russia and the United States.
ties. Although the people who wrote WHO’s constitution could

not have foreseen many of the twenty-first century’s health
challenges, they created an organization that remains critically
important to the health and welfare of humankind.
Advances in medical science in the twentieth century pro-
duced vaccines and treatments for a wide range of diseases.
Recent research involving human stem cells and new discoveries
in molecular biology, including DNA cloning and the Human
Genome Project, offer hope that more diseases can be controlled
or eliminated. Many important victories in the ongoing struggle
against disease have been won. WHO has spearheaded efforts
resulting in the eradication, or elimination, of smallpox. Polio
and Guinea worm disease have almost been eradicated. Polio is
a disease that can cause paralysis by attacking the spinal cord.
Guinea worm disease, which is found mostly in Africa, is caused
by microscopic worm larvae that enter the human body when a
person drinks contaminated water. (Once inside the body, the
threadlike parasite can grow up to 3 feet [0.9 meters] in length!).
Measles, known for its distinctive red skin rash, may be
the next highly contagious disease to be eradicated. In 1980,
measles killed more than 5 million children. From 2000 to 2006,
WHO supported a project that vaccinated an estimated 478 mil-
lion children in 46 high-risk countries. In 2006, an estimated
242,000 people of all ages died from measles, a two-thirds drop
from 2000. In Africa, measles cases and deaths plunged 91 per-
cent over those seven years.
Despite these successes, however, WHO’s goal of advanc-
ing good health care worldwide remains a daunting one. More
than half of the world’s population lives in developing countries.
(Developing countries are also known as less-developed, or low-
income, countries.) More than 100 of the world’s 195 countries
are considered to be developing countries. In these nations, insuf-
ficient nutrition, unsafe drinking water, and poor sanitation com-
bine to create high rates of disease and death. Worldwide, more
than 2.5 billion people live on less than $2 a day. Few poor people
can afford health care. Many live far from health-care services.
Children in many poor families suffer from malnutrition,

which stunts their physical development, impairs their ability to
learn, and weakens their immune systems. (The immune system
is the body’s defense system that protects against viruses, bacte-
ria, and other invaders.) Each year, nearly 10 million children in
developing countries die before they reach their fifth birthday.
Acquired immune deficiency syndrome (AIDS), malaria, respi-
ratory infections, and intestinal diseases remain major killers of
children and adults in the developing world.
More than 6 billion people now live on Earth. By 2100,
the population may reach 10 billion. Research has shown that
as places become more heavily populated, deadly diseases like
cholera and tuberculosis spread more quickly and easily. Citizens
of all nations remain at risk of contracting long-established
diseases and newer, even more dangerous diseases. Modern
improvements in transportation and technology have increased
the flow of information and people between countries. This
trend, known as globalization, will continue to change the ways
countries connect with one another. This increasing connectiv-
ity also allows diseases to spread around the world. Health has
become a responsibility shared by all nations, rich and poor.
It requires fair, universal access to essential health care and
a united defense against highly contagious diseases that can
threaten all nations.
WHO Works to Ensure Good Health

As a specialized agency of the United Nations, WHO is an inter-
governmental organization. Intergovernmental organizations
are permanent international associations focused on specific
global issues. Their memberships are made up of countries.
More than 300 intergovernmental organizations operate in the
world, including such notable groups as the UN, the European
Union, and the World Trade Organization.
The World Health Assembly is WHO’s decision-making
body. Each May, delegations from all 193 member nations meet
in Geneva, Switzerland. At this conference, delegates vote on
many resolutions. These resolutions deal with such matters as

establishing health programs, determining the organization’s
policies, or approving partnerships with other organizations.
WHO’s Executive Board writes the resolutions and presents
them to the delegates. The Executive Board has 34 members,
all of whom are experts in the public health field. Delegates at
the World Health Assembly elect these board members, who
serve three-year terms. Delegates also select WHO’s direc-
tor-general, who serves for five years. The director-general
approves the budgets for WHO programs and also supervises
the work of the organization’s permanent staff. About 8,000
employees, health experts, and other staff members work at
WHO headquarters in Geneva, in 6 regional offices, and in
147 countries.
WHO carries out its mission by providing leadership on a
wide range of global health issues. It influences public health
research worldwide, from the development of vaccines to the
improvement of sanitation practices. The organization pro-
motes cooperation between scientists and health researchers.
Based on scientific evidence, it develops health-policy recom-
mendations for nations to adopt. WHO monitors and assesses
global health trends. It assists nations in addressing global
health problems jointly and helps governments in develop-
ing countries improve their health services. WHO works with
many partners, including other UN agencies (like UNICEF—
the United Nations Children’s Fund), nongovernmental organi-
zations (like the Carter Center), and private corporations (like
drug companies).
These partnerships help WHO achieve its goal of improv-
ing the well-being of people around the world. For example,
WHO responded to a 2002 outbreak of a rare type of menin-
gitis, a fatal disease of the thin covering of the brain or spinal
cord, in the African country of Burkina Faso. WHO staff mem-
bers worked closely with a large pharmaceutical company to
develop a new vaccine. The vaccine was tested and approved in
record time. WHO negotiated with the company to lower the
Members of the 57th World Health Assembly pose for a group photo
during the annual meeting of the 193 member states in May 2004. The
meeting focused on several health topics, including HIV/AIDS, reproduc-
tive health, road safety, dietary habits, and patterns of physical activity.
cost of the vaccine to less than a dollar per injection, a price

that the government of Burkina Faso could afford.
The work did not end there. A more effective, low-cost
meningitis vaccine was scheduled to be introduced in 2009.
With support from WHO, the Meningitis Vaccine Project
signed a deal with the Serum Institute of India to produce 25
million doses of vaccine for African countries over a period
of 10 years. The new vaccine costs 40 cents. Kader Kondé, the
vaccine project’s representative working in WHO’s office in
Burkina Faso, noted, “The advantage of the new vaccine is that
it is going to be affordable.”3
In carrying out its mission, WHO’s global health programs
focus on several key areas:
• prevention of diseases through vaccines and immuni-

zation
• treatment of diseases
• health care for mothers and children in developing
countries
• nutrition
• sanitation, including safe drinking water and proper
disposal of human waste
WHO plays a major role in helping people in all countries

live safer and healthier lives. It helps nations strengthen their
health-care systems, which include national health ministries,
hospitals, clinics, and other medical facilities. WHO also helps
developing nations create programs to increase their national
wealth and improve the well-being of their citizens. It advises
wealthy, developed countries on the health threats to their citi-
zens, such as chronic diseases. These diseases—like stroke, heart
disease, cancer, obesity, diabetes, and asthma—are the leading
killers of people in developed countries. WHO improves global
health security through immunizations, treatment, and speedy
responses to outbreaks of diseases. It publishes reliable public
health information and research.
The importance of WHO’s role is made clear by Winnie
Mpanju, a doctor from Tanzania who works in WHO’s head-
quarters:
Having worked with global and regional health orga-

nizations, national health systems, training institu-
tions, health providers, and donors, I’m convinced that
WHO’s neutral and convening role is indispensable in
addressing health priorities, especially among the poor
and underprivileged. From our policy guidelines and
standard setting to our work with other UN agencies
and partners—all our work at HQ must add value in
countries and benefit the people we serve. That is why
we are here, plain and simple.4
2
The Rise of
International
Public Health
The origins of the World Health Organization can be
traced back to international sanitary conferences that began
in the eighteenth century and to international health organi-
zations founded in the early twentieth century. International
cooperation on health issues began about 700 years ago. In the
fourteenth century, trade and commerce between countries
and continents began to increase as people developed ways to
build ships that could travel farther. The number of goods and
people moving around the globe rose rapidly. Deadly diseases
also began to spread more quickly worldwide.
Europeans made the first efforts at modern public health
policy. Beginning in the fourteenth century, many European
cities and countries passed laws to prevent the spread of dis-
ease. At that time, people did not know what caused diseases.
21
Although cholera is no longer considered a major global health threat,

the disease still heavily affects less developed countries due to a lack
of clean drinking water. Cholera, which spread by trade routes, has
caused millions of deaths due to outbreaks in India, Russia, Western
Europe, and North America since 1816. In this drawing, victims of the
1884 cholera epidemic are waiting to be fed by soldiers in a quarantine
camp on the Franco-Italian border.
They observed that a disease would often spread from house to

house and from village to village. People came to believe that if
they touched a sick person—or even something that belonged
to the person—they could catch the disease.
The government of Venice was the first to take action to
stop the spread of disease. At the time, it was a powerful city-
state. Located on the Adriatic Sea in what is now Italy, Venice
had become a major shipping port on the trade routes between
Europe and Asia and Africa. Each year, its harbor welcomed
hundreds of ships from abroad. These ships brought trade goods
and travelers, as well as diseases that had never been seen before
The Rise of International Public Health 23
in Europe. Because Europeans had not built up natural immu-

nity to these diseases, outbreaks sometimes dispersed quickly.
To prevent diseases from these faraway lands from infect-
ing its citizens, the government of Venice adopted a ground-
breaking law. It required ships from abroad to anchor at an
island outside of the city. The ship had to stay there for 40
days before it was allowed to proceed to Venice’s docks to
unload passengers and goods. Authorities in Venice believed
that within 40 days a person infected with a contagious disease
would either be cured or die. This 40-day period was known
as a quarantena, from the Italian word quaranta (“40”). The
law also required that cargo either be treated with smoke or be
exposed to sunlight. The authorities believed that these meth-
ods made the cargo safe to unload.
Venice’s practice of quarentena appeared to lessen disease
among the city’s population. Other countries began to isolate
arriving ships. In the English language, the practice became
known as a quarantine. Isolating ships from abroad for a set
number of days, however, did not stop epidemics. Such dis-
eases as bubonic plague and typhus still ravaged countries
throughout the world. At the time, no one knew that a rat on
a ship or lice hidden in a traveler’s clothing might be carrying
the microorganisms that cause these diseases. Having no better
way to protect public health, governments continued to enforce
quarantines until the nineteenth century.
International Cooperation
During the early 1800s, the Industrial Revolution spread
throughout Europe and the United States. The development
of scientific knowledge, machinery, and larger businesses
changed the economic, social, and political conditions of many
countries. Goods that had been made in small workshops and
homes for centuries by craftsmen began to be mass-produced
in factories by workers. Cities grew rapidly as people moved
from the countryside to find jobs in factories.
Trade and travel boomed as newfangled steamships and

trains crisscrossed oceans and continents, carrying the goods
produced in the factories. The expansion of trade allowed
diseases to spread more easily. The transportation boom over-
whelmed existing quarantine procedures. Nations responded
The Father of
Modern Public Health
English social reformer Edwin

Chadwick (1800–1890) helped
bring about his country’s first
public health laws. Trained as a
lawyer, Chadwick began to work
in 1832 on a commission mak-
ing revisions to the Poor Laws,
which governed social services
provided to England’s poor. In
this role, Chadwick championed
ideas that were radical for his
time. He argued that the govern-
ment could improve public health
by improving living conditions in English politician and
poor neighborhoods. As a result social reformer Sir Edwin
of the Industrial Revolution, Chadwick, who dedicated
tens of thousands of people his career to sanitary
had flocked to England’s cities, reform and public health
particularly London, in search of in Great Britain.
factory jobs. Crowded, filthy, and
disease-ridden slums grew.
In an 1842 report, Chadwick wrote that diseases in poor
neighborhoods were a threat to all Britons. He asserted that
Britain’s poor had the right to decent living conditions. Five years
by strengthening their quarantine laws. These tougher laws,

however, angered powerful merchants. Longer quarantine peri-
ods created longer delays at ports, harming businesses. Doctors
and government officials noted that the new quarantine laws
had little effect on the spread of diseases.
later, Chadwick headed a commission that studied sanitary condi-

tions in London. The commission’s report advocated separating the
city’s sewage system from its water drainage system.
In 1848, a cholera epidemic struck England, killing as many
as 10,000 people in London. The government took action, adopt-
ing many of Chadwick’s recommendations. Parliament enacted
groundbreaking sanitary and public health laws known as the Public
Health Act of 1848. This act would provide the foundation for
modern public health services.
The Public Health Act set up a government bureau to pro-
vide health education, vaccination programs to control diseases,
and agencies to test and inspect water supplies, foods, and drugs.
It also started government sanitation projects that supplied clean
water and introduced effective trash and sewage removal in neigh-
borhoods rich and poor. (At the time, many people, including
Chadwick, thought that unpleasant odors from sewage and trash
could cause disease.)
The act also established a Board of Health. Chadwick was
appointed as a commissioner. His career in public health did not
last long, however. Chadwick’s reforms met opposition from sev-
eral sources. Political foes did not want to fund his public work
projects. Engineers ridiculed his plans for sewers. Doctors argued
that only doctors should serve on the Board of Health. Chadwick
was pressured to resign from the board in 1854.
To satisfy the demand for more raw materials for their

factories, European businesses began to import these products
from colonies in Africa, Asia, and the Americas. The many
ships returning from ports on these continents increased the
risk of new diseases. Cholera, a disease previously unknown
in Europe, struck the continent in 1831. The epidemic killed
tens of thousands of people. Another cholera epidemic ravaged
Europe in 1848.
Some countries and cities responded to the rise in
epidemics by establishing national sanitary organizations.
The first sanitary organization—the Sanitary, Medicine, and
Quarantine Board of Alexandria, Egypt—was founded in the
1830s. Rather than relying on quarantines to protect people
from diseases being introduced from abroad, these sanitary
organizations focused on improving the living conditions
within their own countries.
In response to the devastating cholera epidemic of 1848,
doctors from many countries felt that action needed to be
taken on an international scale. They organized the first
International Sanitary Conference in 1851. Meeting in Paris,
France, delegates discussed quarantine policies and other ways
to prevent the spread of cholera. Because medical researchers
at the time had discovered very little about cholera (as well as
other diseases), the conference never achieved its goal of pre-
venting the spread of the deadly disease.
Over the next century, countries increased their coopera-
tion on health issues. Individual nations and new international
organizations addressed the most serious threats to public
health. International sanitary conferences were held about
every five years. The delegates to these conferences developed
and adopted guidelines that helped countries to negotiate trea-
ties to control infectious diseases. These agreements focused
mainly on controlling the spread of plague, cholera, yellow
fever, and other diseases from Europe’s colonial territories in
Asia, Africa, and the Americas.
Early Twentieth-Century Organizations

Remarkable new scientific discoveries in the late nineteenth
and early twentieth centuries led to more effective interna-
tional public health rules and policies. By 1900, scientists
had developed an explanation for the cause of some diseases.
It became known as germ theory. According to this theory,
microbes can invade the body and cause some diseases and
infections. Microbes are microorganisms that are too small
to be seen except through a microscope. The discoveries of
French chemist Louis Pasteur, English surgeon Joseph Lister,
and German doctor Robert Koch became the major com-
ponents of germ theory. Recognizing the potential of germ
theory to identify the microbes that cause disease, Pasteur pre-
dicted, “It is in the power of man to make parasitic maladies
disappear from the face of the earth.”5
These scientific and medical discoveries revolutionized
sanitary and public health policies. Government officials began
to adopt public health measures to prevent the spread of dis-
ease. These measures included improving water supplies and
sewage systems and vaccinating healthy people. New public
health laws and procedures reduced the spread of diseases in
communities and between nations. The existing international
treaties and quarantine policies, however, proved less effective.
Changing treaties and quarantine laws took a lot of time. It
was difficult to keep them up to date with the latest scientific
knowledge about infectious diseases. Doctors and government
officials around the world began to encourage the development
of new ways to combat infectious diseases.
The world’s first global health organization was founded
in 1902 by countries in North and South America. The
International Sanitary Bureau collected regional data on the
frequency, cause, and distribution of diseases in the Americas.
It exchanged this epidemiological information with other
health organizations. The association’s name was later changed
to the Pan American Health Organization. The organization
would play an active role in the extensive campaign to eradicate

yellow fever in the Americas.
At the eleventh International Sanitary Conference in 1903,
delegates from around the world agreed that a permanent
international health organization should be created. It could
coordinate quarantine measures worldwide and gather and
publish epidemiological data and information. Four years later,
nine European countries, plus Egypt, Brazil, and the United
States signed the Rome Agreement, which created the Office
International d’Hygiène Publique (OIHP). (In English, the
organization’s name was the International Office of Public
Hygiene.) OIHP’s mission was to distribute to member states
information on general public health, particularly on infectious
diseases and how to combat them. Financed by its member
nations, OIHP had its headquarters in Paris. Within seven
years, membership grew to 60 nations. During its early years,
the organization focused on overseeing and improving interna-
tional quarantine policies. OIHP adopted policies that required
nations to notify it of any outbreak of major infectious diseases,
such as cholera, plague, or yellow fever.
Several pandemics (widespread epidemics) swept through
Europe at the end of World War I (1914–1918) and in the
following years. The influenza wave of 1918–1919 killed an
estimated 15 million to 20 million people. Influenza was not
the only disease that ravaged the continent. In 1919, nearly 2
million cases of typhus were reported in Poland and the Soviet
Union. OIHP did not have the resources to respond effectively
to such large epidemics.
In 1919, 44 nations signed an agreement to establish the
League of Nations. This new organization was the first inter-
national effort to create a cooperative system to settle disputes
between countries. The hope was that diplomacy would help
nations avoid future wars. Among its early activities, the league
set up its own international health organization. The mission
of the Health Organization of the League of Nations would
extend beyond OIHP’s existing role. The League of Nations

gave its agency authority to take a more active role in dealing
with infectious diseases.
With the creation of this new organization, OIHP made
plans to cease operations in 1920 and transfer its responsi-
bilities to the Health Organization of the League of Nations.
OIHP, however, did not close down. The U.S. Senate refused
to approve the treaty that would have made the United States
a member of the League of Nations. Along with two other
nations, the United States kept OIHP operating. It continued to
work independently of the League of Nation’s health organiza-
tion. A rivalry between the two organizations grew.
The Health Organization of the League of Nations focused
its early work on responding to and preventing epidemics. For
example, it worked with the Soviet Union to provide education
on typhus. Its Malaria Commission pursued a new approach to
controlling that infectious disease. The commission abandoned
efforts to develop procedures to prevent the spread of malaria
from country to country. Instead, it studied the disease in the
regions where it was widespread and advised countries on
ways to control the disease locally. The organization’s Cancer
Commission provided doctors and health officials in member
countries with the latest research on various types of cancer.
As an international organization, the League of Nations
proved to be weak and ineffective. It failed in its primary mis-
sion: containing conflict between nations. A new world war
broke out in 1939, eventually involving most of the countries
in the world. World War II halted the operations of both the
Health Organization of the League of Nations and OIHP.
After the war, many countries lay in ruin. The war had killed
about 50 million people worldwide. The world’s nations wanted
to ensure that such a catastrophic war would never occur again.
They banded together to create a much stronger international
organization than the League of Nations. Its primary mission
would be to maintain peace between countries. Representatives
Representatives from 50 countries (later 51) convened in San Francisco to

draw up the United Nations Charter on April 25, 1945. One of the issues
they discussed was the establishment of a global health organization. April 7,
2008, marked the sixtieth anniversary of the World Health Organization.
from the world’s nations met in San Francisco in April 1945.

They drafted a treaty known as the United Nations Charter.
Originally signed by 51 nations, the charter created the United
Nations. (Almost every country has now signed the charter.)
The UN’s mission is to help nations work together on issues of
world peace, international law and security, human rights, and
economic and social development.
The idea for a UN specialized agency for health was pro-
posed at a 1946 meeting of the UN’s Economic and Social
Council. The council agreed to organize an international health

conference. In June 1946, delegates from all 51 UN member
states, along with delegates from 13 nonmember countries, met
in New York City. During the monthlong conference, the del-
egates agreed on a constitution for a new international health
organization.
The World Health Organization formally came into exis-
tence in September 1948, when the twenty-sixth UN member
state ratified WHO’s constitution. It took control of the work
of the Health Organization of the League of Nations and OIHP.
Both organizations were dissolved. Although the two groups
had never worked together, they had provided a foundation
for expanding cooperation among countries to improve global
public health. The world’s other major international health
organization, the Pan American Health Organization, joined
WHO. It became the regional office for the Americas.
In its early years, WHO focused on rebuilding health ser-
vices in war-torn countries. It targeted several key diseases,
particularly malaria, tuberculosis, and sexually transmitted
diseases like syphilis. It also worked hard to improve nutrition,
mother-and-child health, and sanitation standards.
In 1951, WHO produced a new set of international
rules to control infectious disease. The International Sanitary
Regulations established standardized procedures for countries
to notify WHO of any major disease outbreaks and for handling
infected international travelers and cargo. Updated in 1969 and
expanded in 1973 and 1981, these rules are now known as the
International Health Regulations.
During the 1950s, WHO membership grew rapidly. Former
European colonies in Africa, Asia, and Latin America gained
their independence and joined the organization. With more
members, WHO’s budget also grew. It was able to expand exist-
ing programs and projects and to create new ones.
The growth of WHO, however, created a rift among its
member nations. Many of WHO’s newer members were poor,
less-developed countries. During the 1960s and 1970s, they

voiced their desire for the organization to provide different
types of health services. Most of the programs that WHO had
adopted in the past mirrored the health-care models of rich,
developed countries. WHO concentrated its efforts on helping
to build hospitals in large cities and providing health services
to patients suffering from diseases. This approach usually
required highly trained medical staff and expensive medical
technology. The model worked well in rich countries. It was
not a good fit, however, for most poor, developing countries.
They had few well-trained doctors and could not afford the
most up-to-date medical technology. Instead, these countries
wanted WHO to help them develop community-based health-
care systems that were affordable.
During the 1970s, under the leadership of Director-
General Halfdan Mahler, WHO changed its approach. The
organization began to focus on a new health-care model,
known as primary health care. The goal of primary health
care was to provide medical services appropriate to a country’s
needs, wealth, and culture. These community-based systems
would use practical, medically sound, and socially acceptable
methods. They would use technologies that a community and
a country could afford.
To implement primary health-care systems in poor coun-
tries, WHO provided education on common local health
problems and methods to prevent and control diseases. The
organization focused on programs to provide an adequate sup-
ply of food and safe water, basic sanitation methods, proper
nutrition, and mother-and-child health care. It also created
programs that provided essential drugs and vaccinations
against major infectious diseases.
WHO’s primary health-care programs helped build hun-
dreds of rural health centers. Thousands of community health
workers were trained worldwide. The movement away from
high-tech, urban hospitals expanded the reach of public health
in developing countries. These new low-tech, locally appropri-

ate, community-based approaches helped improve the health of
many more people.
During the 1980s, WHO faced many difficult challenges.
Disagreeing with the direction of the UN, the United States
began to withhold funds from the UN and its agencies, includ-
ing WHO. Without funding from the UN’s richest member
state, WHO suffered a financial shortfall. Having less money in
its budget had a major impact on many programs.
Other organizations also began to enter the field of inter-
national health care during the decade. Another UN special-
ized agency, the World Bank, began to work in the health field.
Founded in 1944, the World Bank was created to provide loans
and other grants to developing countries. It became well known
for its successes in helping developing countries improve their
government services, develop their financial sectors, and build
their infrastructures. Its loans helped to build roads, bridges,
and dams throughout the developing world. In the 1980s, the
World Bank began to provide loans to developing countries to
build up their health programs. By 1990, it became the larg-
est source of money for health-care programs in the world.
The World Bank began to hire public health professionals and
started its own health programs. Other UN organizations, such
as UNICEF and the UN High Commission on Refugees, also
developed their own health programs. The European Union
and various nongovernmental agencies, such as the Red Cross,
also created health programs. These new competitors and their
health programs made WHO’s role in international public
health less clear.
Still, WHO continued to combat new challenges. WHO’s
Global Program on AIDS was one of its major successes in the
1980s. In 1987, the UN General Assembly recognized HIV/
AIDS as a “worldwide emergency” and called on WHO to play
the “essential directing and coordinating role” within the UN
in fighting HIV/AIDS.6 WHO received funding from many
sources, enabling it to hire staff to develop national HIV/AIDS

strategies for more than 170 countries.
During the 1990s, WHO began to refashion itself. While
the World Bank’s greatest advantage was its tremendous
economic influence, it recognized that WHO had consider-
able expertise in health and medicine. In 1998, Gro Harlem
Brundtland, a physician and former prime minister of Norway,
became WHO’s director-general. She wanted to turn WHO
into an organization that influenced others on the global scene.
She began to strengthen WHO’s financial position and orga-
nized global partnerships that brought together private donors,
governments, and international agencies.
In 2008, WHO celebrated its sixtieth anniversary. WHO
remains the foremost source of scientific and technical knowl-
edge in international public health. It shares the information
it gathers with its member nations and other international
organizations through meetings, publications, and cooperative
programs. WHO has also taken on the role of the world’s health
conscience. It advocates principles of equality in health care for
all of the world’s people.
3
WHO at Work
The World Health Organization has three major
branches: the World Health Assembly (WHA), the Executive
Board, and the Secretariat. These three groups determine
WHO’s policies and carry out its programs in order to fulfill
the organization’s mission to provide leadership on global
health issues.
WOrld HEaltH assEMBly

The World Health Assembly is the legislative and policy
branch of WHO. Since 1948, the assembly has met each year,
usually in May, for two weeks at WHO’s headquarters in
Geneva, Switzerland. The assembly consists of representatives
from all 193 member states. Each nation has one vote but may
send up to three representatives to the annual conference.
35
Representatives of other international and nongovernmental

organizations also attend the sessions as observers.
The assembly’s representatives vote on a wide range of
resolutions, from creating public health policies and adopting
international health regulations to approving the organization’s
budget. The goal is for representatives to reach a consensus on
each resolution presented to them. The assembly approves a
resolution if it receives two-thirds of the total vote. A presi-
dent, who is selected by the assembly, chairs the annual con-
ference. Representatives express their views on resolutions and
A WHO Resolution
The sixty-first session of the World Health Assembly adopted a reso-

lution to develop a global plan to reduce the harmful use of alcohol.
In many countries, the use of alcohol causes a substantial health,
social, and economic burden. In its resolution, the assembly urged
member states “to collaborate with the Secretariat in developing a
draft global strategy on harmful use of alcohol based on all evidence
and best strategies.”* It also requested the WHO director-general “to
ensure that the draft global strategy will include a set of proposed
measures recommended for states to implement at the national level,
taking into account the national circumstances of each country.”**
The director-general was also instructed “to collaborate and consult
with member states as well as consult with intergovernmental organi-
zations, health professionals, nongovernmental organizations, and eco-
nomic operators on ways they could contribute to reducing harmful
use of alcohol.”*** The assembly asked the director-general to submit
a draft of the WHO global strategy to reduce harmful use of alcohol
to the 63rd World Health Assembly, via the Executive Board.
WHO at Work 37
encourage all nations to follow WHO directives. The assembly

also supervises and evaluates the work of the Executive Board
and the Secretariat.
More than 2,700 participants from 190 nations met at the
61st World Health Assembly held in 2008. They took action
against new threats to global public health. In 2008, the assembly
endorsed a major resolution to promote pharmaceutical research
and development. It adopted new approaches to improve and
make more affordable the development of drugs to prevent and
treat diseases that have a major impact on developing countries.
The World Health Assembly was particularly concerned about

alcohol use by teens. Alcohol is the number one drug of choice
for young people, and its use has become a major cause of teen
injuries (particularly from traffic accidents), violence and crime
involving teens (especially domestic violence, assaults, rapes, and
vandalism), and premature teen deaths (drownings, fires, suicides,
and homicides). Alcohol use also has a negative effect on school
attendance and performance. A 2007 study provided evidence that
young people around the world are starting to drink at an earlier
age. Drinking by young people can cause physical harm to the brain,
which continues to mature until age 25.
* Sixty-First World Health Assembly. Agenda item 11.10, WHA61.4., May 24,
2008, “Strategies to Reduce the Harmful Use of Alcohol.” Available online
at http://www.who.int/nmh/WHA%2061.4.pdf.
** Ibid.
*** Ibid.
WHO at Work 39
The assembly also approved a six-year plan to reduce the effects

of chronic diseases, such as cardiovascular diseases, diabetes,
and cancers. These diseases cause about 60 percent of all deaths
worldwide. The assembly adopted another resolution that urged
member states to address the impact of climate change on health.
It also directed the Secretariat to help countries in reaching a
higher percentage of immunization and to encourage the devel-
opment of new vaccines. Although vaccines prevent as many as 3
million deaths a year, the assembly noted that WHO vaccination
programs should be expanded.
The Executive Board

WHO’s Executive Board is responsible for making sure that
resolutions passed by the World Health Assembly are carried
out. Six regional committees nominate member nations to
serve on the board. Each country that is elected to join the
Executive Board then selects a qualified health expert to serve
as a board member. Members of the Executive Board custom-
arily do not act as representatives of their respective govern-
ments. Instead, they are counted on to make their decisions in
the best interests of international public health.
The 34 board members serve three-year terms. Each year,
about one-third of the Executive Board members are replaced.
The Executive Board usually includes members from at least
three of the five permanent members of the United Nations
Security Council. Those countries are China, France, Russia,
the United Kingdom, and the United States.
The Executive Board meets twice a year. In January, board
members meet to prepare for the annual World Health Assembly
(Opposite page) The mission of WHO is “the attainment by all peoples

of the highest possible level of health.” All UN members are eligible to
join WHO. Currently there are 193 member states. The World Health
Assembly is the supreme decision-making body of WHO and is com-
posed of health ministers from member states.
conference held in May. They draft agendas, resolutions, and

budget proposals for assembly representatives to consider.
After the conference, the Executive Board meets to take care of
administrative tasks. Its duties also include drafting the WHO’s
six-year strategic plan, known as the General Program of Work.
The board also advises the Secretariat on constitutional or orga-
nizational issues. The Executive Board has the power to take
emergency measures whenever necessary.
The Secretariat
The Secretariat is responsible for carrying out WHO’s day-
to-day operations. It includes the director-general, doctors,
public health professionals, and administrative workers. The
Secretariat has three main divisions: headquarters, regional
offices, and country offices. About one-third of WHO employ-
ees work in each of these divisions. The WHO is more decen-
tralized than most of the other 13 UN specialized agencies.
More than 8,000 people work for WHO. They come from
many countries and serve for a set period of time.
The Director-General
The director-general is the executive head of WHO. She or
he serves as the organization’s top public health officer and as
its chief administrative officer. The director-general’s respon-
sibilities include appointing WHO staff, preparing annual
financial statements, and representing WHO in UN meetings
and other events.
An amendment to WHO’s constitution spells out the nec-
essary qualifications for a director-general. These include a
strong background in public health, the ability to manage a
large organization, and an understanding of cultural, social,
and political differences between nations. Member states can
recommend qualified applicants for the director-general post.
From these many candidates, the Executive Board chooses a
WHO at Work 41
Margaret Chan was elected director-general of WHO by the Executive

Board on November 8, 2006. Chan was selected over 12 other can-
didates to become leader of the organization due to her successful
handling of the 1997 avian flu outbreak and the 2003 SARS outbreak
in Hong Kong. During that time she was the first female head of Hong
Kong’s Department of Health.
nominee. The World Health Assembly then votes to approve

the nomination. Once approved, the director-general serves a
five-year term.
The director-general and many other employees work in
WHO’s headquarters in Geneva, Switzerland. In 1948, WHO
took charge of the offices of the former Health Organization
of the League of Nations. The organization moved its head-
quarters into its own new building in 1968. Besides its many
offices, WHO’s headquarters has conference halls, an extensive
medical and public health library, and facilities for printing and
distributing its many publications.
Regional Offices
Regional offices are responsible for carrying out the decisions
of the World Health Assembly and the Executive Board within
their respective regions. The director-general oversees the
work of the regional offices. The six regional offices are:
1. Regional Office for Africa, headquartered in Braz-

zaville, Congo.
2. Regional Office for the Americas, headquartered in
Washington, D.C.
3. Regional Office for the Eastern Mediterranean, head-
quartered in Cairo, Egypt.
4. Regional Office for Europe, headquartered in Copen-
hagen, Denmark.
5. Regional Office for Southeast Asia, headquartered in
New Delhi, India.
6. Regional Office for the Western Pacific, headquar-
tered in Manila, Philippines.
The regional offices allow WHO to build good relationships

and maintain effective contact with national governments. This
is a key function because these governments are responsible for
implementing many of WHO’s programs and initiatives. These
offices also monitor regional health issues.
Each regional office differs in structure and personnel,
depending on the specific needs of the region. Each region
has a committee made up of representatives from its member
states. Each committee nominates a director for its region; the
Executive Board appoints the director.
The regional director serves as both the public health and
the administrative head of the regional office. Because of the
decentralized nature of WHO, regional directors play a major
role in the organization. They are responsible for planning and
managing programs. They also oversee their region’s budget and
appoint WHO representatives to country offices in their region.
WHO at Work 43
Country Offices
Country offices are located within each member state. They
are often based in the host country’s national health depart-
ment. Professional staff members, temporary technical advis-
ers and consultants, and support staff work in country offices.
A WHO representative heads each country office. The repre-
sentative keeps the regional director informed of any special
health problems in the country.
The main function of country offices is to develop and
manage programs at the country level. They work with the
country’s national health department to implement a wide
variety of WHO programs and policies. For example, WHO’s
Bangladesh office worked with that country’s Ministry of
Health and Family Welfare to implement programs that provide
safe drinking water. According to some estimates, high levels of
arsenic in the water supplies in some areas of Bangladesh cause
about 200,000 deaths a year. Prolonged consumption of high
levels of arsenic can lead to cancers, heart diseases, diabetes,
and other serious health problems. Other examples of WHO
country programs are the WHO Collaborating Center on
Ultraviolet Radiation and Its Health Effects in Bolivia and the
WHO Health System Review in Estonia.
Norwegian doctor Eigil Sörensen is WHO’s country rep-
resentative in Papua New Guinea. “I enjoy contributing to
tackling major public health problems in countries,” Sörensen
observed. “Working as WHO representative is a challenge. It
requires the use of personal and technical skills and knowledge,
and provides many opportunities to influence important health
programs. I enjoy finding the right balance between working
with the country while also being an independent observer and
advocate for people’s health needs.”7
WHO in Action
The public health leaders who founded WHO wanted the
organization to operate in almost every field of global health.
WHO’s constitution provides a broad framework for the orga-

nization to meet its objective to attain the highest level of health
for the world’s people. Article 2 of the constitution names 22
specific functions for the organization to pursue. The most
basic function is to adopt resolutions, make agreements, and
establish regulations to improve global health. These activities
provide the foundation for WHO’s wide variety of programs,
publications, and partnerships.
Health Programs
Much of WHO’s work is focused on health programs and proj-
ects. The organization is perhaps best known for its efforts to
eradicate diseases and control outbreaks of infectious diseases.
When a country asks for help, WHO provides appropriate
technical assistance, including medical services and training
as well as emergency aid.
WHO provides direct assistance to governments to respond
to specific health needs or to strengthen national or local health
systems. Low- and middle-income countries receive most of
this type of assistance. In providing services, WHO follows the
principle that every nation’s sovereignty (self-rule) should be
respected. Each country has the right to develop its own health
system and services in a way that its government finds most
sensible and appropriate to its needs.
WHO operates a wide variety of health programs and proj-
ects. A few programs and projects that demonstrate WHO’s
range and reach are:
• Diabetes Program, which seeks to prevent diabetes,

help diabetics, and raise awareness of the disease.
• Department of Control of Neglected Tropical Diseases,
which seeks to eliminates yaws, Chagas’ disease, lep-
rosy, schistosomiasis, and other tropical diseases. In
2004, the department announced that its efforts had
WHO at Work 45
helped eliminate yaws—a disease that primarily affects

the skin, bones, and cartilage—in India.
• Department of Ethics, Trade, Human Rights, and
Health Law, which helps ensure that all WHO pro-
grams and policies incorporate the principles of dig-
nity, justice, and security.
• Global Database on Child Growth and Malnutrition,
which compiles data from nutritional surveys con-
ducted around the world since 1960.
• Health Workforce, which provides education, train-
ing, and other services to improve the distribution and
performance of health workers.
• Global Advisory Committee on Vaccine Safety, which
monitors and responds to vaccine-safety issues of
worldwide importance.
WHO also provides emergency assistance to nations in

need. Epidemics, wars and political unrest, and natural disas-
ters like earthquakes, floods, and hurricanes often strike with-
out warning. Major health emergencies can occur anywhere
in the world. In May 2008, for example, WHO responded to a
powerful earthquake that struck China. Centered in Sichuan
Province, the earthquake affected more than 350 million
people in eight provinces. It damaged or destroyed more than
16 million buildings. Five million people were displaced. More
than 65,000 people were killed, and about 100,000 were hos-
pitalized with injuries. WHO worked with the UN’s Disaster
Management Team and China’s Ministry of Health to iden-
tify priority needs and obtain supplies. Once the short-term
health services were provided, WHO’s Communicable Disease
Working Group focused on lessening the risk factors for chol-
era, measles, pneumonia, and other communicable diseases.
This work involved providing safe food, clean water, and
adequate shelter.
After a series of devastating tsunami in southern Asia killed more

than 225,000 people in 11 countries, WHO partnered with several
organizations to provide emergency assistance. WHO reported that, in
addition to the grief felt from the loss of loved ones, homes, livelihood,
and entire community networks, there was also a shortage of mental
health workers to offer counseling. In response, WHO and its partners
trained community-based workers to incorporate a culturally appro-
priate approach for each region.
Research and Health Information

Two key WHO functions are promoting and conducting
research and collecting health statistics and epidemiological
information. WHO publishes health information in a variety
of publications. Launched in 1995, World Health Report is
WHO’s most important publication. It reports on the state
of human health worldwide, providing up-to-date statistical
data on major health issues and the health status of specific
WHO at Work 47
population centers. This data gives countries, donor agencies,

international organizations, and other users the latest medical
and public health information they need to make policy and
funding decisions. The report also provides students, health-
care professionals, and others with critical information on
international health issues.
World Health Report focuses on a specific theme each year.
The 2008 World Health Report, for example, proposed ways
to improve primary health-care systems. Subtitled Working
Together for Health, it identified four goals:
1. Achieving universal access to primary care.

2. Restructuring health-care services to meet patients’
needs and expectations.
3. Adopting better national health-care policies to attain
healthier communities.
4. Encouraging more effective government participation.
Other WHO publications include World Health Statistics

Annual and World Health Statistics Quarterly, International
Lists of Causes of Death, International Nomenclature of Diseases,
and International Health Regulations.
WHO also enacts international rules that establish stan-
dards and naming conventions for foods, pharmaceuticals, and
similar products. To foster the global exchange of health infor-
mation and ideas, WHO also promotes cooperation among
scientists and public health experts.
Accomplishing Its Mission

Each year, the World Health Assembly adopts a General
Program of Work report, which outlines the organization’s
primary activities for the next six years. The report provides
a broad framework for WHO’s policies. All activities noted in
the report relate to WHO’s core functions:
• Providing leadership on issues critical to global public

health.
• Encouraging the creation and distribution of valuable
medical and public-health knowledge.
• Setting norms and standards for public health.
• Creating health-care policy options that are based on
scientific evidence and ethical considerations.
• Providing technical support and developing sustain-
able programs.
• Monitoring global public health and assessing trends.
To carry out its mission, WHO often partners with other

international organizations in joint projects. For example, the
Roll Back Malaria Partnership is a coordinated effort to reduce
cases of malaria worldwide. The United Nations Development
Program, UNICEF, the World Bank, and WHO launched the
partnership in 1998. Since its founding, the partnership has
grown, with new members including nongovernmental orga-
nizations, private corporations, and countries where malaria
is endemic. World Blood Donor Day, another partnership
program, promotes blood donation around the globe. WHO
cosponsors the event with the International Federation of
Blood Donor Organizations, the International Society of Blood
Transfusion, and the International Federation of Red Cross and
Red Crescent Societies.
Organizational Challenges
WHO faces two major organizational challenges: overcoming
the strained relations between member nations and achieving
its mission despite a limited budget. Both of these challenges
have proven difficult to solve in the past. They require diplo-
macy, negotiation, and the development of new approaches to
funding the organization.
Since the 1960s, international politics and an increased
sense of regionalism have led to conflicts at the World Health
WHO at Work 49
Assembly. (Regionalism is a sense of shared identity and

goals expressed by countries in a specific geographical area.)
These conflicts have made it more difficult for the Secretariat
to carry out WHO programs. The most serious ongoing rift
among WHO members is between rich and poor members.
Governments of poor nations disagree with the governments
of wealthier nations on what WHO’s mission should be. Most
poor- and middle-income nations want the organization to
focus its resources on helping their governments combat
specific diseases and strengthen national primary health-care
systems. Wealthier countries see a narrower mission for WHO.
They want the organization to concentrate its efforts on man-
aging disease programs, providing technical expertise, and
gathering and distributing international public health informa-
tion. This tension has hindered the effectiveness of WHO.
Money to operate WHO comes from two sources: regular
budget funds and extra-budgetary funds. Regular budget funds
come from the contributions charged to each member state.
Nations do not all make the same contribution. Each nation’s
payment is based on its ability to pay, which is determined by
its wealth and population. Wealthy countries—including the
United States, Germany, and Japan—make larger contribu-
tions to WHO than poorer countries like Somalia, Nicaragua,
and Cambodia.
Extra-budgetary funds come from donations to the organi-
zation. Member states often provide funds in addition to their
regular contributions. Other UN organizations, private orga-
nizations, and individuals also donate money to WHO. Some
of these donations are given for a specific program or use. For
example, the United States made large donations to WHO’s
malaria- and smallpox-eradication programs. When a dona-
tion comes with attached conditions—for example, it must be
spent on mother-and-child health—the Executive Board must
review the donation. If the board approves of the conditions,
WHO can accept the donation. In the 1990s, extra-budgetary
funding surpassed regular budget funding for the first time.

This change occurred as WHO shifted its focus from disease
programs to primary health programs. The future success of
WHO’s programs will depend on the commitment of its mem-
ber nations and access to adequate financial resources.
4
The UN Millennium
Development
Goals
In 2000, representatives from 189 nations met at the
United Nations’ Millennium Summit. They adopted a ground-
breaking initiative called the Millennium Declaration. They
agreed that their common goal was to “free our fellow men,
women, and children from the abject and dehumanizing con-
ditions of extreme poverty, to which more than a billion of
them are currently subjected.”8 One hundred and forty-seven
nations signed the declaration. For the first time in history,
most of the world’s governments committed themselves to
improving the lives of people worldwide by addressing poverty
and poor health. Low-income countries pledged to improve
their health policies and governance. They also agreed to
increase their accountability to their citizens. Wealthy coun-
tries promised to provide the resources needed.
51
In the Millennium Declaration, nations agreed to a set of

eight goals. The fulfillment of these goals would end extreme
poverty by 2015. To ensure that governments would work
toward reaching the goals, each nation agreed to have the
progress of its development activities monitored. In addition,
major international financial institutions—such as the World
Bank, the International Monetary Fund, and the World Trade
Organization—agreed to be accountable for achieving the
goals. As one of the United Nations’ specialized agencies, WHO
also promised its support and agreed to help achieve the goals
of the Millennium Declaration.
Millennium Development Goals

To meet the world’s main development challenges, the Millen-
nium Declaration stressed a wide range of actions and targets.
The declaration identified eight specific goals to be achieved
by 2015. These became known as the Millennium Develop-
ment Goals. They are:
Goal 1 Eradicate extreme poverty and hunger.

Goal 2 Achieve universal primary education.
Goal 3 Promote gender equality and empower women.
Goal 4 Reduce child mortality.
Goal 5 Improve maternal health.
Goal 6 Combat HIV/AIDS, malaria, and other diseases.
Goal 7 Ensure environmental sustainability.
Goal 8 Build a global partnership for development.
To achieve these goals, the UN also adopted various targets

for each one. Meeting these targets would show how much
progress had been made toward the goals.
The adoption of the millennium goals had a profound
impact on the work of WHO. Health issues are a major part
of the goals. Three of them deal directly with health: reducing
child mortality, improving maternal health, and combating
The UN Millennium Development Goals 53
In July 2007, the WHO regional office in India released the Millennium
Development Goals Report 2007, an annual statistical survey produced
at the request of the UN General Assembly that outlines their region’s
global and regional progress toward the Millennium Goals. This report
came at the midpoint of a 15-year effort to implement a set of eight key
development objectives that world leaders pledged to achieve by 2015.
HIV/AIDS, malaria, and other diseases. Health is also a com-

ponent of the other five goals.
WHO is strengthening its presence within member nations
to help those countries meet their goals, and it is working
with other UN organizations to identify indicators for each
health-related goal. WHO monitors and tracks progress
within countries, helping to identify programs and methods
that make a measurable improvement in public health. This
chapter examines WHO’s role in achieving goals 4 and 5 and
its less central role in achieving goals 1, 2, 3, 7, and 8. The next
chapter focuses on the organization’s major role in achieving
Goal 6, combating HIV/AIDS, malaria, and other diseases.
Reducing Child Mortality

Child-mortality statistics demonstrate the importance of Goal
4—reducing the number of child deaths. Nearly 10 million
children under the age of five die each year. About 4 million
infants each year die within the first 28 days of life. Nearly 99
percent of childhood deaths occur in low- and middle-income
countries, mostly in sub-Saharan Africa and South Asia.
Studies have shown that many of these deaths would be
preventable if children had access to community-based health
services. Six major diseases or factors cause about 90 percent
of all deaths of children under the age of six. They are diar-
rhea, HIV/AIDS, malaria, measles, neonatal causes (such as
infection, premature delivery, and lack of oxygen at birth), and
pneumonia. Malnutrition and the lack of safe water and sanita-
tion contribute to about half of all these children’s deaths.
One target of Goal 4 is to reduce by two-thirds the mortal-
ity rate of children under the age of five. In 1990, 93 children
out of every 1,000 born died before reaching age five. The goal’s
target is to reduce that number to 31 out of every 1,000 by 2015.
(By comparison, industrialized countries have an average rate
of six deaths by age five for every 1,000 children.)
In meeting this goal, WHO is working with other inter-
national agencies and national health departments to reduce
the rate of child deaths. It provides technical advice (including
information on combating specific diseases) and policy sup-
port (such as training for health-care workers). To help doctors,
researchers, and public health officials better understand child
mortality, WHO collects data on the under-five mortality rate,
the infant mortality rate, and the proportion of one-year-old
children who have been immunized against measles.
Working with UNICEF, WHO has developed the Global
Immunization Vision and Strategy. This strategy aims to
immunize more people, with a focus on children, throughout
the world. Its main goal is, by 2015, to reduce illness and death
due to vaccine-preventable diseases by at least two-thirds of the
2000 level. The program also seeks to introduce new vaccines,

ensure access to good-quality vaccines, and monitor vaccina-
tion programs. WHO’s immunization efforts have helped save
the lives of many children. Serigne Dame Leye, chief of Nguoye
Diaraf village in the West African nation of Senegal, praised a
WHO immunization program, saying, “We used to bury two or
three children every week during measles epidemics. This does
not happen anymore.”9 In 2008, WHO worked with UNICEF
to help the Ivory Coast conduct a nationwide measles vaccina-
tion campaign. More than 3 million children age nine months
to five years received a vaccination.
The estimated price tag for immunization activities for
2006–2015 is $35 billion. One-third of this amount will be
allocated to buying vaccines. The remaining two-thirds will be
spent on creating immunization delivery systems. WHO and
UNICEF estimate that the Global Immunization Vision and
Strategy’s vaccination program will save 10 million lives.
WHO’s Children’s Environmental Health program works
to support safe, healthy, and clean environments for young
people. Of the world’s 6.7 billion people, 1.8 billion are age
14 or younger. Child survival and development depend on
having a safe, healthy, and clean environment. Environmental
factors, such as the presence of irrigation water, cause about
90 percent of malaria cases worldwide. (Infected mosquitoes
transmit malaria to humans by carrying malaria protozoa
from person to person. They reproduce by laying their eggs in
stagnant water.) About 800,000 children under the age of five
die from malaria each year. Eighty percent to 90 percent of
diarrhea deaths worldwide are related to contaminated water,
inadequate sanitation, and other environmental conditions.
Diarrheal diseases claim the lives of about 1.7 million children
every year. Environmental conditions, such as smoke from
cooking fires, are a factor in as many as 60 percent of acute
respiratory infections. Such infections annually kill an esti-
mated 2 million children under the age of five.
Today, immunizations save more than 3 million lives. Still, 15 million

people die each year from preventable diseases due to lack of access to
basic health care and immunizations. In response, WHO has pledged to
help developing countries to immunize all children and eligible adults.
It has had several successes in the Western Pacific region within the
last decade, including achieving polio-free status and the reduction of
measles deaths by 95 percent.
The Children’s Environmental Health program educates

and trains health-care providers on how to diagnose, man-
age, and prevent children’s diseases linked to environmental
risk factors. It promotes research into children’s environmen-
tal health. This research helps transfer medical knowledge
from wealthy countries to middle- and low-income coun-
tries. It also helps developing countries build health-care
systems to deal with environmental risk factors. Two notable
WHO environmental-risk research projects focus on asthma
in children and on the effects of arsenic poisoning during
pregnancy on children.
Through the efforts of the Children’s Environmental Health

program, many countries have begun to identify and assess the
environmental influences that affect the health and develop-
ment of their youngest citizens. Many low- and middle-income
countries have prepared a children’s environmental health
profile. These profiles provide a sound basis for countries and
communities to set priorities for action, to plan appropriate
environmental health programs, and to evaluate the progress
that they have made.
WHO’s Department of Child and Adolescent Health and
Development promotes the health, growth, and development of
young people from birth to age 19. It strives to speed up efforts
by nations to improve the health and development of their young
populations. The department has developed 25 strategies to
achieve its goals. This enables each country to choose a strategy
that is most appropriate for its specific needs. The department’s
major goals are to reduce the rate of infant and child deaths
and the rate of HIV infection among people aged 15 to 24. The
department has one of WHO’s largest research programs. It sup-
ported two medical studies that examined potential treatments
for pneumonia that could be administered in patients’ homes in
developing countries. The department also works with external
partners. For example, it joined with UNICEF to develop a field
manual for community-based health-care workers to use when
treating severe malnutrition.
With the help of these WHO programs—and others—
some countries have made remarkable progress. In 2007,
global child deaths reached a record low, falling to 9.7 million.
(Representing a drop to 68 deaths per 1,000 live births in 2007.)
Excellent progress was made in many countries, included
Bangladesh, Bolivia, Laos, Malawi, Niger, and Vietnam. These
countries are on course to reach their child mortality reduction
targets by 2015. Basic public health measures have had a major
impact on these improvements. These measures have included
measles immunizations, the use of insecticide-treated nets to
prevent malaria, and programs to improve nutrition, sanita-

tion, and water quality.
Improve Maternal Health

More than a half million women worldwide die each year dur-
ing pregnancy and childbirth—about 1,500 deaths every day. In
sub-Saharan Africa, for example, 6 percent of women are at risk
of dying during pregnancy or childbirth over a lifetime. In com-
parison, only 1 in 2,800 women in wealthy countries face the
same risk. Millennium Development Goal 5 seeks to improve
maternal health to lower the number of deaths of mothers and
their infants. One of the goal’s targets is to reduce the maternal
mortality rate between 1990 and 2015 by three-quarters. Most
women who die in childbirth do so because there is not enough
skilled primary and emergency care available where they live.
A Success Story
Each year, more than 400,000 women die during childbirth in sub-
Saharan Africa. One country has started an innovative training
program to help lower maternal death rates. In Mozambique, about
10 percent of women died during childbirth in 1992. By 2008, the
nation’s maternal death rate had dropped to less than 5 percent.
In 2004, the government launched a new program to train mid-
wives to perform cesarean sections and other emergency childbirth
surgeries. (A cesarean section is a surgical delivery of a baby that
involves making cuts in the mother’s abdomen and uterus.) Surgeons
usually perform these types of operations, but Mozambique has only
three doctors for every 100,000 people. By training midwives to
perform these surgeries, the country has been able to provide more
mothers with medical services during childbirth, particularly in rural
WHO’s first major effort to improve maternal and newborn

health started with its Safer Motherhood Initiative. Launched in
1987, this program partnered with other international agencies
to address maternal mortality. Through the initiative, several
countries made significant progress in reducing deaths among
mothers and their newborns. Mother and child mortality, how-
ever, did not drop in many other countries. In response to the
Millennium Development Goals, WHO reorganized the Safer
Mother Initiative. Its new program, the Making Pregnancy
Safer Initiative, increased WHO’s efforts to improve mother
and newborn health.
In 2005, WHO expanded the Making Pregnancy Safer
Initiative, creating a new department to oversee the organi-
zation’s work on maternal health. The Department of Making
Pregnancy Safer assists countries to ensure that mothers
areas hundreds of miles from the nearest hospital. The midwives go

through intensive training. One midwife, Emilia Cumbane, noted, “I
think it’s a good profession—to produce people.”* The Mozambique
midwife-surgery program shows how low-cost, community-based
programs can improve public health in low-income countries. WHO’s
director-general, Dr. Margaret Chan, observed that the Mozambique
program “is a story of courage. It is a story of innovation.”**
* “Wide Angle: Birth of a Surgeon—Midwives in Mozambique.” PBS.

Available online at www.pbs.org/wnet/wideangle/episodes/birth-of-a-surgeon/
introduction/747/.
** “Wide Angle: Birth of a Surgeon: Aaron Brown Interview: Dr. Margaret
Chan.” PBS. Available online at www.pbs.org/wnet/wideangle/episodes/birth-
of-a-surgeon/aaron-brown-interview-dr-margaret-chan/1810/.
receive skilled care before, during, and after pregnancy and

childbirth. The department also works to strengthen national
health systems to provide mother and child care. WHO pro-
vides guidelines for safe pregnancy and childbirth and encour-
ages countries to use them. These guidelines may save the lives
of as many as 400,000 women each year. In some parts of the
world, such as North Africa and Southeast Asia, more pregnant
women now have greater access to health care. The department
has staff working in more than 75 countries.
The Other Goals

Besides taking on a major role in meeting the Millennium
Development Goals focused on health, WHO has accepted
responsibility to assist global efforts to achieve the other
goals. The WHO staff is working with member nations and
other international agencies to eradicate extreme poverty and
hunger, achieve universal primary education, promote gender
equality and empower women, ensure environmental sustain-
ability, and develop a global partnership for development.
Some WHO efforts, such as its work to strengthen health-care
systems worldwide, have an impact on more than one of the
millennium goals.
Eradicate Extreme Poverty and Hunger

To fulfill Millennium Development Goal 1, the United Nations
has established two targets. One target is to halve, by 2015, the
proportion of people who suffer from hunger. WHO assists in
achieving this target by focusing on two specific population
groups. First, it works to reduce the percentage of underweight
children younger than age five. Second, WHO works to reduce
the percentage of people who regularly consume less than the
average recommended daily nutrition requirement.
Nutrition is a key factor in good health and normal child-
hood development. Malnutrition makes people more vulner-
able to infection and disease. Better nutrition contributes to
better health. Healthy people are stronger and more productive.

Programs that improve the nutrition of poor people can help
them establish a better quality of life. WHO has collaborating
centers for nutrition in 14 countries, including Brazil, Canada,
France, Iran, Thailand, and Tanzania. These centers cooperate
with other WHO personnel at the global, regional, and national
levels. The centers promote all WHO policies related to nutri-
tion. They collect information on good nutrition and distrib-
ute it to local people. They also provide nutrition training to
health-care workers and work with other WHO departments
on nutrition research.
Achieve Universal Primary Education

One of the targets in Millennium Development Goal 2 is to
ensure that, by 2015, children everywhere will be able to com-
plete a full course of primary schooling. Good health plays a
crucial role in the ability of students to complete their primary
schooling. Healthy children learn better. WHO’s Global School
Health Initiative was launched in 1995. It works to strengthen
health promotion and education activities at all levels, from
local to global. The initiative is designed to improve the health
of students, school personnel, families, and other members of
the community through school health programs.
In response to the Millennium Declaration, the Global
School Health Initiative began to focus on increasing the
number of health-promoting schools. WHO defines a health-
promoting school as one that is “constantly strengthening its
capacity as a healthy setting for living, learning, and work-
ing.”10 WHO has worked with such international agencies as
UNESCO (United Nations Educational, Scientific, and Cultural
Organization), UNAIDS (the Joint United Nations Program
on HIV/AIDS), and the United States’ Centers for Disease
Control and Prevention to build regional networks to develop
health-promoting schools. WHO also conducts research on
ways to improve school health programs. It also works with
national health and educational agencies to develop programs

to improve student health. For example, WHO helped China
create a program educating students about HIV/AIDS and
other sexually transmitted diseases.
Promote Gender Equality and Empower Women

Millennium Development Goal 3 commits nations to promote
gender equality and empower women. Women need special
attention in health because they have unique health problems
and risks. In addition, improving the health of women is an
effective way to improve the health and prosperity of entire
families. Healthy women can better care for their families and
maintain employment.
In 2007, the World Health Assembly passed a resolution to
make sure that gender issues were considered in all of the orga-
nization’s work. WHO is helping to achieve this millennium
goal by working to ensure gender equality in health-care ser-
vices worldwide. WHO defines gender equality as “the absence
of discrimination —on the basis of a person’s sex—in providing
opportunities, in allocating resources and benefits, or in access
to services.”11 WHO’s Gender, Women, and Health program
focuses on increasing knowledge about biological, social, and
cultural issues that have an impact on health. Because women
face unequal access to health care in almost all countries, the
Gender, Women, and Health program seeks to increase aware-
ness about how gender affects health and to develop policies
that increase gender equality in health.
Ensure Environmental Sustainability

To fulfill Millennium Development Goal 7, the UN has set as
two of its targets to cut in half the proportion of people with-
out sustainable access to safe drinking water and sanitation
by 2015 and to achieve a significant improvement in the lives
of at least 100 million slum dwellers by 2020. Environmental
hazards, like unsafe water and air pollution, are responsible
for about one-fourth of all diseases worldwide. In developing

countries, the main diseases caused by environmental factors
are malaria, diarrheal diseases, lower respiratory infections,
and injuries. In developed countries, healthier environments
could lower the number of cases of cancer, cardiovascular dis-
eases, asthma, and other diseases.
WHO estimates that as many as 13 million deaths could
be prevented each year by making the world’s environments
healthier. WHO’s Public Health and Environment program
works on a wide range of projects to improve environmental
health. It promotes projects to provide safe water, improve
hygiene, and adopt cleaner and safer home fuels. Other projects
focus on increasing the safety of buildings, improving chemi-
cal safety, and reducing air pollution and the harmful effects of
electromagnetic fields and ultraviolet radiation. The program
also sponsors research on the effect of global environmental
change on health.
Building a Global Partnership for Development

One target in Millennium Development Goal 8 is to provide
access to affordable, essential drugs in developing countries.
WHO’s Health and Development program has helped nations
establish their own lists of essential medicines. Most countries
have developed these lists, but 19 developing nations have yet
to create one or update their outdated list. An essential-medi-
cines list contains those drugs that would satisfy the medical
needs of most of the people in a country; these drugs should
be available and affordable. WHO also provides assistance
to nations in drafting medicine policies to govern the sale of
essential drugs.
Several countries have made remarkable progress toward
improving the affordability of essential drugs to combat
HIV/AIDS, malaria, and tuberculosis. WHO continues to
work with partners to provide access to essential drugs in
developing countries. For example, in 2001, the organization
Experts estimate that the number of children dying unnecessarily from

infectious diseases could be reduced by 2 million if good sanitation and
water supplies were provided. WHO predicts that by 2015, 2.1 billion
will still lack basic sanitation, and at the present rate sub-Saharan Africa
will not reach the target until 2076. Above, a woman fills jugs with water
at a water distribution point in the Naguru Go Down Slum in Kampala.
partnered with a Swiss pharmaceutical company to provide

people in several countries with an antimalarial medicine at a
significantly reduced price.
Progress Toward the Goals

The Millennium Development Goals have had a major impact
on the policies and work of WHO, other UN agencies, inter-
national organizations, and developing countries. Progress,
however, has been slow. The health-related goals and targets
that WHO embraced are unlikely to be achieved in many parts

of the world.
To meet the goals, the health-care systems of developing
countries need to be strengthened substantially. Without bet-
ter health-care systems, countries cannot provide adequate
programs for disease prevention and control. The resources
needed to make effective improvements, however, are not
available in most of these nations. The Millennium Declaration
asked for wealthy countries to make a commitment to provide
higher levels of aid. A significant percentage of this aid has
yet to be donated. A worldwide economic crisis that struck
in 2008 hit wealthy nations particularly hard. It has hindered
their ability to meet aid commitments. Even if efforts to achieve
the health-related millennium goals fall short of the objectives
established in 2000, WHO’s efforts will have made a meaning-
ful difference in the lives of millions of people in the world’s
poorest countries.
5
Combating
HIV/AIDS, Malaria,
and Tuberculosis
Most people know about WHO because of its world-
wide efforts to prevent, control, and eradicate infectious dis-
eases. It has developed key programs to combat the threats
to global public health posed by a wide range of infectious
diseases. WHO also plays a central role in achieving the objec-
tives of UN Millennium Development Goal 6. This goal seeks
to halt, by 2015, the spread of HIV/AIDS, malaria, and tuber-
culosis and to begin to reverse their spread.
HIv/aIds
The human immunodeficiency virus, or HIV, is a type of
retrovirus. Retroviruses are particularly dangerous because
they can make copies of themselves inside healthy cells that
they have invaded. The HIV retrovirus attacks many different
66
Combating HIV/AIDS, Malaria, and Tuberculosis 67
types of cells. Most importantly, it can harm T-helper lym-

phocytes and other cells that make up the human immune
system. By invading these cells, HIV weakens the body’s own
defense against diseases.
HIV is transmitted through bodily fluids. The primary
means of transmission is through sexual contact. Intravenous
drug users who share needles also face a high risk of contract-
ing the virus. HIV can be transmitted via transfusions of blood.
(This is rare in developed countries, where blood is screened
for HIV before being used.) HIV can also be passed from a
mother to an infant during pregnancy, childbirth, and breast-
feeding. The chance of this type of transmission is as high as
25 percent before and during childbirth and slightly higher
through breastfeeding.
Scientists believe that HIV originated in sub-Saharan
Africa. It spread to the Caribbean and then to the United States
and Europe. They think that viruses in monkeys that weaken
their immune systems mutated to HIV in humans who ate
monkey meat. The first reports of a rare and deadly form of
pneumonia appeared in 1981. Within a few years, AIDS had
become widespread and was recognized as a specific disease.
In more than half of HIV cases, the infection is not detected
in the early stages. The symptoms are often too mild to be noticed.
These symptoms include fever, muscle aches, sore throat, a red
rash, and a swelling of lymph glands. It can take 10 years or more
for a person infected with HIV to notice major symptoms. As
the infection slowly progresses, however, the person’s immune
system becomes weaker. That makes a person more vulnerable
to infections, such as tuberculosis and influenza.
Once under control in most of the world, tuberculosis has
made a dramatic comeback in the past two decades. A person
with HIV is 20 times more likely to contract tuberculosis.
Tuberculosis is the leading cause of death among those with
HIV/AIDS. As AIDS spreads, so does tuberculosis. As much
Although a 2008 study found that the death rates for HIV-infected
patients decreased dramatically after the introduction of antiretroviral
(ART) drugs, AIDS activists warn against complacency and ask that
governments fill a multibillion dollar funding gap. Experts expect that in
2015 there will be 40,000 orphans in Honduras if preventive measures
are not taken now. Above, members of Asociacíon de Mujeres march
during World AIDS Day in Tegacigalpa, Honduras.
as one-third of the world’s people may carry the tuberculosis

bacteria. Each year, an estimated 2 million people a year die
from the disease.
The most advanced stage of HIV infection is called
acquired immunodeficiency syndrome, or AIDS. HIV infec-
tion becomes AIDS when the cells in a person’s immune system
have been destroyed. The AIDS epidemic has killed more than
25 million people. The number of people living with HIV in
2007 was 33 million. More than half were women. A new HIV
infection occurs about every 15 seconds. Today, the rate of new
HIV infections is rising more quickly among heterosexuals.
HIV/AIDS has its greatest impact in developing countries.

Ninety-five percent of new infections occur in developing
countries. Africa has the largest number of cases, but the infec-
tion rate is climbing in South Asia and Southeast Asia. The
disease reveals the health-care disparity between rich and poor
nations. In the poorest countries, people with HIV/AIDS often
die without any medical care. Surveys in countries where HIV/
AIDS is growing have found that as many as 90 percent of teens
have never even heard of the disease. In wealthier countries,
HIV/AIDS patients have access to antiretroviral drugs. These
medications can slow down the development of AIDS and dra-
matically improve the lives of HIV/AIDS patients.
In the United States, HIV has spread from large cities to
small towns and rural areas. AIDS was once the leading cause
of death for Americans aged 25 to 44. It now ranks second
after accidents. Antiretroviral drugs and other therapies have
reduced the number of AIDS-related deaths in the United
States and other developed countries.
Millions of deaths could be prevented in poor countries by
using these drugs and therapies.
WHO’s HIV/AIDS Efforts

WHO is a key player in the global effort to halt and reverse the
spread of HIV/AIDS. Within the Joint United Nations Program
on HIV/AIDS, known as UNAIDS, WHO is responsible for the
global health response to the disease. WHO’s primary goal is to
enable member nations to make a comprehensive and sustain-
able health response to HIV/AIDS within their borders.
The task of halting and reversing the spread of HIV/AIDS
is daunting. Nearly 3 million new cases of HIV/AIDS are diag-
nosed each year. More than 2 million people die of diseases
related to HIV/AIDS each year. Only about 20 percent of peo-
ple at high risk of HIV infection have access to the information
and tools needed to prevent infection. Millions of HIV/AIDS
patients are in urgent need of antiretroviral drugs.
WHO supports a public health approach to HIV preven-

tion, treatment, care, and support. To accomplish this goal,
WHO works with countries to develop straightforward treat-
ment guidelines, decentralize health-care services, and give
less-specialized health workers a larger role in treatment, care,
and support.
WHO staff in all six regional offices and in 193 countries
provide technical support and develop standards to prevent
HIV/AIDS and to treat patients. The prevention programs seek
to provide information, change behaviors to reduce HIV risks,
and distribute condoms and sterile needles. WHO staff also
train local health workers and provide advice on the most effec-
tive treatments. The most effective way to fight AIDS, WHO
believes, is to increase the involvement of local communities
and strengthen primary health-care services. WHO works to
increase patients’ access to treatments. WHO’s AIDS Medicines
and Diagnostic Services team helps member nations acquire
and distribute affordable drugs and other medical supplies.
WHO’s HIV/AIDS Department is its unit dedicated to
preventing and controlling HIV/AIDS. It develops HIV/AIDS
policies and guidelines, and supports nations in strengthen-
ing their capabilities to combat HIV/AIDS and acquiring HIV
medications. It also monitors the global spread of HIV/AIDS
and promotes greater attention to the epidemic.
Different teams within the HIV/AIDS Department work in
specific areas of expertise. Among these teams are Antiretroviral
Treatment and HIV Care, Systems Strengthening and HIV,
and Strategic Information and Research. The HIV/AIDS
Department is a member of the Cluster for HIV/AIDS,
Tuberculosis, Malaria and Neglected Tropical Diseases.
The HIV/AIDS Department works closely with other WHO
departments, programs, and teams. More than 30 other WHO
departments carry out HIV/AIDS-related projects, including
those working in the areas of blood safety, disease surveillance,
sexual and reproductive health, and health education. These
departments collaborate with other UN agencies, international

development agencies, national health ministries, and local
health-care providers in HIV/AIDS-related work. WHO’s
broad goal is to improve HIV prevention programs, enable
people to know their HIV status, increase access to treatment
and care, and strengthen national and local health systems.
WHO’s Child and Adolescent Health and Development
program works to prevent mother-to-child transmission of
HIV, improve the care and treatment of infants with HIV
Making a Difference
Deepak and Rosy Khadgi, an HIV-positive couple in Nepal, started

a nonprofit organization, Sahara Plus, to offer counseling and other
services to HIV-positive people. They visit schools to talk to young
people about sex, drugs, and AIDS. They also distribute antiretrovi-
ral drugs to HIV-positive patients who travel to their village from
rural areas to pick up their medications.
Deepak was diagnosed with HIV in 1990. The couple has been
married since 1995. They have two children who are HIV-negative.
To fund Sahara Plus, Deepak makes and sells paintings that depict
village life in his country. “My wife and I have been through a lot of
pain, mostly because of the people who shunned us and shooed
us away,” he said. “We’re not very educated. But we know enough
about life that helping others is a kind of art. While I’m alive, I need
to do as much as I can for as many people as I can.”*
* Portraits of Commitment: Why People Become Leaders in AIDS Work. Bangkok,

Thailand: Asia Pacific Leadership Forum on HIV/AIDS and Development,
2007, p. 59. Available online at www.aplfaids.com/documents/SA_Portraits_
book.pdf.
infection, and prevent HIV in teens. The Stop TB Department

integrates HIV/AIDS into its tuberculosis prevention and
care programs. The Immunization, Vaccines, and Biologicals
Department supports research to develop HIV vaccines. The
Reproductive Health and Research Department works to
include HIV/AIDS in programs to prevent and control sexually
transmitted infections, and it supports research on improving
the reliability of condoms. The Essential Health Technologies
Department provides advice on blood transfusion safety and
health-care worker protection.
In 2008, WHO produced a comprehensive collection
of recommendations titled Priority Interventions: HIV/AIDS
Prevention, Treatment, and Care in the Health Sector. Published
as a book, CD-ROM, and Web site, the package described the
most important and up-to-date policies and methods that
politicians, public health officials, and health-care workers can
use to tackle HIV/AIDS in their countries. WHO designed
Priority Interventions to help low- and middle-income coun-
tries achieve broad access to HIV/AIDS prevention, treatment,
and care services.
Millennium Development Goal 6 and HIV

The UN’s Millennium Development Goal 6 committed the
world’s nations to combat HIV/AIDS and other diseases.
WHO, in its primary role in coordinating global HIV/AIDS
efforts, has two targets. The first is to halt and begin to reverse
the spread of HIV/AIDS by 2015. The second is to achieve, by
2010, universal access to treatment for HIV/AIDS for all those
who need it.
WHO monitors several health indicators to track the suc-
cess of global HIV/AIDS efforts. For instance, WHO sponsors
studies that assess HIV among young pregnant women (aged
15 to 24) and the rate of condom use.
WHO’s efforts have resulted in progress in some areas. Its
work to strengthen national prevention programs has lowered
the number of new HIV cases. Its HIV prevention programs

have successfully reduced risky sexual behaviors in many parts
of the world. For example, the rate of global condom use has
increased. The global growth of antiretroviral treatment services
has also lowered the number of AIDS-related deaths worldwide.
Despite these victories, HIV/AIDS continues to take a
terrible human toll, especially in sub-Saharan Africa. More
than 7,000 people worldwide become infected with HIV each
day. More than 5,000 people a day die from AIDS. The rate
of women contracting HIV infection is increasing worldwide.
The greater effectiveness and wider availability of antiretro-
viral drugs and other HIV/AIDS treatments has resulted in
many patients living longer lives. The number of people living
with HIV increased from 29.5 million in 2001 to 33 million in
2007. Many national health systems, however, cannot handle
the treatment and care needs of larger numbers of HIV/AIDS
survivors. Predicting the future of AIDS is difficult. It will
continue to be one of the most critical challenges facing global
public health.
Malaria
Malaria is a serious infectious disease that occurs most fre-
quently in tropical climates. It is caused by four specific species
of parasites. Plasmodium falciparum (the deadliest form) and
Plasmodium vivax are the two most common types. About 40
percent of the world’s population faces the threat of malaria.
Most people at risk live in the world’s poorest countries.
More than 500 million people become ill with malaria each
year. Most cases and deaths occur in sub-Saharan Africa. The
disease also occurs in Asia, the Middle East, Latin America,
and some parts of Europe. Malaria presents different threats
to different countries. Some regions of the world have a steady
number of malaria cases throughout the year. Other areas
experience malaria cases only during certain parts of the year,
usually during a rainy season.
Widespread malaria epidemics can erupt in regions where

people have had little or no exposure to malaria. These epi-
demics are usually caused by unusual weather conditions
that expand the range of mosquito populations. Disasters or
other events can also lead to malaria epidemics when large
numbers of people move into regions with malaria. Travelers
from countries that do not experience malaria are always
particularly at risk.
Mosquitoes spread malaria among humans. When a
female mosquito bites a person with malaria, it ingests blood
containing the malaria parasites. When the mosquito bites
another person, it passes the malaria parasites into that
person’s bloodstream. Once in the bloodstream, the parasites
travel to the person’s liver. There, they multiply quickly and
re-enter the bloodstream in huge numbers. By the time symp-
toms appear, thousands of parasites have clogged blood vessels
and caused blood cells to burst. Malaria symptoms include
chills alternating with fever, fatigue, headache, nausea, and an
enlarged spleen.
Malaria can be treated and prevented with a wide variety
of medications, including chloroquine and mefloquin. Early
diagnosis and immediate treatment help control the disease
and prevent life-threatening complications from developing.
If left untreated, malaria can disrupt the blood supply to the
body’s organs. In many parts of the world, the malaria para-
sites have developed resistance to antimalarial drugs. These
new drug-resistant strains pose a serious threat to global
public health.
Malaria results in enormous social and economic costs
in countries where it is endemic (common in a particular
location). It lowers job and school attendance, contributes
to poverty, and discourages foreign investment and tourism.
WHO estimates that malaria causes an average drop of more
than 1 percent of economic growth in countries with large-
scale malaria problems. Over the years, this loss has resulted
in significant differences in economic output between nations

with malaria and those without. Low-income countries hit
hard by malaria struggle to control or eliminate the disease.
A large percentage of their public health budgets is directed
toward malaria treatment and prevention.
WHO’s Malaria Efforts

WHO’s Global Malaria Program coordinates its efforts to
combat malaria worldwide. The program provides member
nations with advice on policy and strategies to prevent, con-
trol, and treat malaria. It recommends that countries adopt
four malaria strategies:
1. Prevention through techniques that protect against

mosquito bites.
2. Immediate treatment of malaria with effective
drugs.
3. Special focus on protecting young children and preg-
nant women.
4. Strengthening national capacities to detect and react
to malaria epidemics.
The specific malaria policies appropriate for a nation will

depend on many factors. The type of malaria (parasite species),
patterns of disease transmission, the prevalence of drug-resis-
tant strains, and various political and economic issues must
be considered in order to develop an effective and affordable
national malaria program.
The Global Malaria Program also participates in the Roll
Back Malaria Partnership. Created in 1998, the partnership’s
goal is to reduce malaria worldwide so that it no longer is a major
cause of death or a major obstacle to economic development.
It works to promote increased investment in national health
systems in order to provide effective malaria prevention and
treatment to populations most at risk. The partnership supports
Employees in Guilin, China, wrap the malaria drug artesumate for

exporting. WHO listed the artesumate injection by the Guilin
Pharmaceutical Company as the first choice in emergency treatment
for malaria. The company is the only producer of the drug in China
that has met WHO requirements. It has kept the price of the drug in
Africa, a region that suffers worst from malaria, at only 60 percent of
the cost for pharmaceuticals produced by Western companies.
research into new and more effective tools (including a promis-

ing vaccine that is being developed) against malaria. Besides
WHO, partners include the United Nations Development
Program, UNICEF, the World Bank, nations, foundations,
research institutions, and privately owned companies.
Millennium Development Goal 6 and Malaria

The UN’s Millennium Development Goal 6 committed the
world’s nations to combat malaria and other diseases. WHO
plays a primary role in coordinating global malaria efforts.
WHO’s target is to halt and begin to reverse the spread of malaria

by 2015. To measure its progress toward this target, WHO closely
monitors two global health indicators: (1) malaria’s prevalence
and death rate and (2) the percentage of people in at-risk areas
who are using effective prevention and treatment measures.
A 2008 UN report concluded that more progress had been
made in treating malaria than in preventing it. New malaria
treatment strategies are effective but have not expanded
adequately into high-risk regions. The report also noted an
encouraging increase in the use of insecticide-treated mos-
quito nets in high-risk regions, lowering the infection rate. The
global distribution of mosquito nets, however, fell short of UN
goals. WHO has achieved success in some malaria regions. In
South Africa’s KwaZulu-Natal province, for example, malaria
cases plunged by 90 percent from 2000 to 2004. Several fac-
tors contributed to this remarkable achievement, including
health education, a government program to spray indoors with
pesticides, and the commitment and hard work of the national
government, community groups, and international agencies.
Tuberculosis
Tuberculosis, or TB, is a serious infectious respiratory disease
that primarily affects the lungs. A bacteria, Mycobacterium
tuberculosis, causes the disease. An infection that solely affects
the lungs is known as pulmonary tuberculosis. An infection
that starts in the lungs sometimes spreads to other parts of the
body, including bones, joints, blood vessels, kidneys, ovaries,
and skin.
Tuberculosis is spread when an infected person coughs,
sneezes, or exhales. Tiny droplets containing the tuberculosis
bacteria are released into the air. People nearby can inhale the
droplets into their nasal passages and lungs. An infected person
may show various symptoms, including a persistent cough, loss
of appetite, chest pains, and difficulty breathing. Tuberculosis
is not highly contagious. It usually requires close or prolonged

contact to be transmitted. The immune systems of healthy
people usually prevent the bacterial infection from spreading.
About 9 million new cases of tuberculosis are reported
each year. Worldwide, a new infection occurs every second.
The disease kills about 2 million people annually. Over the
next 20 years, a billion people are likely to become infected
with tuberculosis; 35 million will die from it. About one-third
of the world’s population is already infected with the tuber-
culosis bacteria. Only 5 to 10 percent of people with tubercu-
losis ever become sick or infectious. People with HIV/AIDS,
however, are particularly vulnerable to tuberculosis infections.
They have a 20-times greater chance of acquiring the disease.
Regional increases in tuberculosis cases have mirrored regional
increases in HIV/AIDS.
WHO’s Tuberculosis Efforts

WHO has several programs and partnerships that help mem-
ber nations build health systems to prevent, treat, and cure
tuberculosis. The organization began its Stop TB Strategy in
2006. The key element of the strategy is DOTS (which stands
for directly observed treatment, short-course), WHO’s long-
running tuberculosis-control program. Since 1995, DOTS-
related programs have treated more than 22 million patients
worldwide. Through the Stop TB Strategy, WHO seeks to
expand and enhance the DOTS program, find new approaches
to preventing and combating tuberculosis in HIV/AIDS
patients, and support new research on tuberculosis.
The Stop TB Strategy has made good progress toward its
DOTS targets. It is very close to achieving the target percentage
of new cases to be treated under DOTS. The program has also
nearly met its treatment success rate target. Although cure rates
in Africa and Eastern Europe were lower, the average DOTS
cure rate is about 85 percent. WHO’s 2007 Global TB Control
Report showed that 26 countries had met their DOTS targets,
including China and Vietnam, two nations with high numbers

of tuberculosis cases. WHO believes that the number of world-
wide tuberculosis cases peaked in 2005. It remains confident
that, if the Stop TB Strategy continues to be implemented,
infections and deaths can be cut in half by 2015 in all regions
of the world except Africa and Eastern Europe.
WHO is the lead agency of the Stop TB Partnership.
Established in 2000, the partnership seeks to eliminate tuber-
culosis as a public health threat. Its key mission is to make sure
that every tuberculosis patient has access to effective medical
care and treatment. It also works to stop the transmission of
tuberculosis by developing new policies and public health
approaches to the disease. Other partners include the United
Nations Development Program, UNAIDS, many nations, and
international agencies.
In 2008, the Stop TB Partnership published Luìs Figo and
the World Tuberculosis Cup, a comic book that informs teens
about tuberculosis and how to prevent it. In the comic book,
real-life Portuguese soccer star Luìs Figo captains the teenaged
Stop Tuberculosis Team, which plays against a team of tuber-
culosis germs. In a statement released when the comic book
was published, Figo urged young people to take its message
seriously: “Tuberculosis is a killer, and I want all of you to stay
safe from it. I am passing the ball to you—you can help reach
the goal of stopping tuberculosis.”12
WHO has joined with other international agencies and
organizations in the TB/HIV Working Group. The group
develops policies and methods to control HIV-related tuber-
culosis. It supports cooperation between organizations and
people fighting against tuberculosis and those fighting against
HIV/AIDS. This collaboration will help HIV patients avoid
tuberculosis infection and improve services to HIV patients
who have contracted tuberculosis.
The main challenge facing WHO in achieving its tubercu-
losis target is the rise of drug-resistant strains of the disease.
Successful diagnosis of extensively drug-resistant tuberculosis (XDR-TB)

relies on the patients’ access to quality health-care services. Since this
new strain of the disease emerged from the mismanagement of treatment
and improper diagnosis, WHO fears that XDR-TB could become a major
killer in parts of Africa hit hardest by AIDS where governments have been
slow to roll out TB control programs.
These new strains have become increasingly difficult to treat

because all of the major anti-tuberculosis drugs have little
effect on them. The drug-resistant strains appear to be spread-
ing. Drug-resistant tuberculosis can be treated with chemo-
therapy, a much more invasive and expensive treatment.
6
Preventing
and Controlling
Chronic Diseases
Chronic diseases are illnesses that have long durations
and are usually never completely cured. Heart attacks, strokes,
cancer, diabetes, and asthma are the most common types.
Chronic diseases are the leading cause of death in the world,
accounting for 60 percent of all deaths. In developed countries,
they make up as much as 70 percent of all deaths. WHO has
documented a troubling trend in the global surge of chronic
diseases. They are causing an increasing percentage of deaths
in developing countries. About 80 percent of all deaths from
chronic diseases now occur in developing countries. A 2008
WHO publication noted, “As populations age in middle- and
low-income countries over the next 25 years, the proportion of
deaths due to [chronic] diseases will rise significantly.”13
1
Each year, about 17 million people die from chronic diseases.

Three major factors—unhealthy diet, a lack of physical activity,
and tobacco use—underlie many chronic diseases. If these fac-
tors were controlled or eliminated, as much as 80 percent of heart
disease, stroke, and diabetes cases could be prevented. Likewise,
30 percent of cancer cases could be prevented. To protect the
health of people worldwide, several WHO departments and pro-
grams focus on preventing and controlling chronic diseases.
Cardiovascular Diseases
Cardiovascular diseases are a group of several diseases that
afflict the heart and other parts of the circulatory system.
Coronary heart disease (which can result in a heart attack)
and cerebrovascular disease (which can result in a stroke) are
the two most common types of cardiovascular disease. Block-
ages that prevent blood from flowing to the heart or the brain
are the main causes of heart attacks and strokes, respectively.
Blood clots or build-ups of fatty deposits inside blood vessels
typically cause these blockages. Other types of cardiovascular
diseases include peripheral arterial disease, rheumatic heart
disease, and congenital heart disease.
The primary risk factors that lead to cardiovascular dis-
eases are unhealthy diets, lack of physical activity, and use of
tobacco products. Other risk factors include poverty, stress,
and aging. These factors often lead to high blood pressure, high
blood-sugar levels, and obesity. Cardiovascular diseases often
have no symptoms until a heart attack or a stroke occurs.
Cardiovascular diseases are the number one cause of death
worldwide, making up about 25 percent of all deaths. WHO
estimates that nearly 8 million people a year die from heart
attacks, and almost 6 million die from strokes annually. WHO
projects that, by 2015, nearly 20 million people will die each
year from cardiovascular diseases. Cardiovascular diseases
also have a significant social and economic impact. They often
Preventing and Controlling Chronic Diseases 83
strike middle-aged people, affecting their ability to work and

threatening the finances of their families.
Through its Department of Chronic Disease and Health
Promotion, WHO seeks to prevent early deaths and disability
due to cardiovascular diseases. To achieve this goal, WHO staff
works to help people worldwide avoid the factors that can lead
to cardiovascular diseases. By changing people’s health behav-
iors, about four out of five premature deaths from heart disease
and stroke could be prevented. A person can greatly reduce the
risk of suffering from a cardiovascular disease (as well as other
chronic diseases) by:
• eating a healthy diet that includes plenty of fruits and

vegetables and excludes foods high in salt, sugar, or fat.
• maintaining a healthy body weight.
• engaging in regular physical activity.
• avoiding tobacco smoke.
WHO offers national health agencies advice on how to

adopt effective programs and policies to provide healthy meals
for students, encourage physical activity, and control tobacco
use. It also supports national efforts to improve access to afford-
able medications and medical devices that treat cardiovascular
diseases. WHO supports efforts to raise awareness of the effects
of cardiovascular diseases, particularly among poorer segments
of national populations.
Cancer
Cancer is a group of nearly 100 diseases. All types of cancer
share two key characteristics: uncontrolled growth of abnormal
cells in the body and the ability of these cells to spread to other
parts of the body. Cancer originates with a change in a single
cell. External agents that can cause cancer—such as viruses, hor-
mones, chemicals, or radiation—work together with hereditary
The theme for WHO’s 20th World No Tobacco Day, held on

May 31, 2009, was “Tobacco Health Warnings.” Tobacco kills
half of all who use it, yet it is common throughout the world
due to its low cost, aggressive marketing, and inconsistent
public policies against it. WHO approves of warnings incor-
porating both pictures and words because they have been
shown to be most effective in getting users to quit.
factors to cause this cellular change. If the spread of abnormal

cells is not controlled, it can result in death.
Tobacco use is the primary risk factor that leads to cancers.
Other risk factors include aging, alcohol use, unhealthy diet,
obesity, air pollution, and infections like HIV and hepatitis B.
These factors can trigger vital changes in the body, transform-

ing a normal cell into a precancerous lesion and then into a
malignant tumor.
Cancer has become one of the leading causes of death
worldwide. It accounts for about 8 million deaths a year, or 13
percent of all deaths. WHO has documented that more than 80
percent of all cancer deaths occur in low- and middle-income
countries. WHO projects that, by 2030, annual cancer deaths
will rise to 10 million. Lung, stomach, liver, colon, and breast
cancer are the types of cancer that cause the most deaths.
A 2005 cancer study concluded that about 30 percent
of cancer deaths could be prevented if nations adopted bet-
Cancer Takes Its

Toll on a Family
In 2004, doctors told 45-year-old Miriame Nnamusoke that she

had cervical cancer. The illness forced her to stop working as a
farmer in her small village in Uganda. She went to a private hospital
to receive treatment. Her life savings soon ran out, however, and
she had to leave the hospital. Her daughter dropped out of school
to care for her. Losing their home, they moved in with Miriame’s
brother in Kampala, the country’s capital. He struggled to support
his two sons, along with his sister and his niece.
Miriame received radiotherapy treatments in a Kampala hos-
pital, but she was not cured. The disease had been diagnosed too
late. Miriame’s situation is common in many low-income countries,
where basic screening for chronic diseases is not widely available.
A nongovernmental organization, Hospice Africa-Uganda, sent a
health-care worker to visit Miriame every two weeks. The worker
provided counseling and pain-relief medication to ease Miriame’s
suffering until she died.
ter cancer-prevention methods and expanded early-detection

programs. National prevention methods include providing
guidance and incentives for people to avoid or reduce key risk
factors, developing vaccination programs for the hepatitis B
virus and other infectious diseases linked to cancer, and con-
trolling environmental hazards at workplaces and in neigh-
borhoods. Two important elements needed for effective early
detection of cancer are:
1. education to help people recognize early signs of can-

cer and know when to seek medical care.
2. screening programs, such as mammograms to detect
breast cancer, to identify early signs of cancer.
Early detection is important because the earlier a cancer is

diagnosed, the more effective treatments are. The goal of early-
detection programs is to find the cancer before it spreads to
other parts of the body.
Many effective treatments exist to help cancer patients.
Some types of cancer have high cure rates when detected early
and treated through surgery, chemotherapy (a treatment that
uses special chemicals), and other methods. These treatments
typically require laboratory tests and such technologies as
ultrasound and endoscopy. In places where medical resources
are scarce, affordable treatments can prolong the lives of
patients and improve their quality of life. Dr. Catherine Le
Galès-Camus, WHO’s assistant director-general for noncom-
municable diseases and mental health, noted, “It is possible,
even in very economically constrained environments, to be
effective in preventing cancer and improving access to quality
services for patients who need such services.”14
To improve methods to prevent, cure, and treat cancer,
WHO launched its Global Action Plan Against Cancer in
2007. The primary goal of the initiative is to help member
nations develop their own national cancer programs. WHO
seeks to include partners from both the public and private

sectors and make sure that programs are integrated into other
national public health programs. The agency stresses that
these national cancer programs should not exclude poor peo-
ple and should be cost-effective so that countries can afford
to maintain the programs in the future. WHO provides sup-
port to nations to improve their primary health-care systems
and their specialized treatment programs for cancer patients.
It also supplies essential medicines and technologies for can-
cer treatment and patient care. WHO provides assistance to
ensure that nations can adopt new cancer strategies and treat-
ments as quickly as possible.
On the international level, WHO works with other UN
agencies and other partners on broad projects to prevent and
control cancer. It supports new cancer research and distrib-
utes the latest scientific evidence and information to member
nations. WHO develops standards and practices to guide the
planning and implementation of international programs for
cancer prevention, early detection, and treatment.
In 2003, the World Health Assembly negotiated WHO’s
Framework Convention on Tobacco Control. The treaty sought
to create effective programs to combat tobacco use. There are
more than one billion smokers in the world. Tobacco is a risk
factor for six of the eight leading causes of death. It kills about
half of the people who use it, and tobacco smoke poses serious
health risks to nonsmokers. Secondhand smoke causes cancer,
heart disease, and many other serious illnesses. Nearly half of
all children in the world breathe air polluted by tobacco smoke.
The smoke makes their asthma conditions worse and causes
dangerous diseases.
Tobacco use is the foremost preventable cause of death
worldwide. It kills more than 5 million people a year, account-
ing for 10 percent of adult deaths annually. Tobacco use is
growing worldwide. If the current trend continues, WHO
projects that tobacco will kill more than 8 million people
annually by 2030 and as many as a billion people during the

twenty-first century.
Most tobacco use begins during adolescence. Today, more
than 150 million teens use tobacco. WHO urges governments
to protect the world’s 1.8 billion young people by imposing
a ban on all tobacco advertising and promotional and spon-
sorship efforts by tobacco companies. In 2008, Dr. Margaret
Chan, WHO’s director-general, declared, “Reversing this
entirely preventable epidemic must now rank as a top priority
for public health and for political leaders in every country of
the world.”15
Obesity and Overweight

Obesity is an abnormal accumulation of body fat. Overweight
is an excessive accumulation of fat. A measurement called
body mass index (BMI) helps determine whether a person
is obese or overweight. To calculate BMI, multiply a person’s
weight in pounds by 703 and then divide that number by the
square of the person’s height in inches. (In the metric system,
BMI is calculated by dividing the person’s weight in kilograms
by the square of the person’s height in meters.) BMI provides
only a rough guide. It may not provide an accurate result
because degrees of fatness vary among individuals. Some BMI
charts, for example, have separate scales for men and women
and separate ideal weight ranges for people of the same height
who have different body frames (small, medium, and large).
WHO considers a person obese if he or she has a BMI
equal to or more than 30. It considers a person overweight if
she or he has a BMI of 25.0 to 29.9. Research has shown that
the risk of chronic diseases begins to increase once a person’s
BMI reaches 21. About 1.6 billion adults (15 years old or older)
worldwide are overweight. About 400 million adults are obese.
WHO projects that, by 2015, as many as 2.3 billion adults
will be overweight, and 700 million will be obese. In the past,
obese and overweight people were mostly found in wealthy
countries. Over the past decade, they have risen significantly

in low- and middle-income countries. Adults are not the only
people affected. More than 22 million children worldwide
under five years old are overweight.
The primary cause of obesity and overweight is a person
consuming more calories than he or she burns. The body
stores excess calories as fat tissue. Researchers believe that
genetic factors, psychological factors, and social factors con-
tribute to weight gain. Some diseases, including hypothryoid-
ism, and the use of steroids and certain other drugs can also
cause weight gain.
Several factors have played a major role in the dramatic
worldwide increase in people who are obese or overweight.
Around the world, people’s diets have changed. Many people
now eat more foods that are high in sugars and fat. Many
people have also become less physically active. Increased
urbanization, the wider use of motorized transportation, and
changes in the types of jobs (more people working in offices,
for example) have contributed to a shift in many people’s
calorie balance.
Being obese or overweight can lead to serious health prob-
lems. Higher BMI is a risk factor for such chronic diseases as
heart attack and stroke, diabetes, arthritis, and some cancers.
It can also lead to high blood pressure, shortness of breath,
pregnancy complications, sleeping disorders, and emotional
and social problems. Studies have shown that obese children
are more likely to die young or experience a disability when
they become adults.
Obesity and overweight, and the chronic diseases related to
them, are mostly preventable. People can reduce their BMIs by:
• limiting their intake of fats and sugars.

• eating more fruits, vegetables, whole grains, and nuts.
• increasing physical activity (a minimum of 30 minutes
of moderately intense activity on most days is needed).
Obesity and overweight now affect 50 to 65 percent of the

population, not only in North America, Europe, and Australia,
but also in lower- to moderate-income countries. WHO
estimates that India has about 37 million diabetes patients,
and by the year 2025 it could reach 57.5 million. Above, men
hold a banner during a walk advocating the prevention of
obesity, diabetes, and heart diseases in New Delhi, India.
Through its Global Strategy on Diet, Physical Activity, and

Health, WHO works to achieve worldwide adoption of healthy
diets and regular physical activity. The Department of Chronic
Diseases and Health Promotion leads WHO’s efforts on diet
and physical activity. It works with international partners, gov-
ernments, and private enterprises to create healthier environ-
ments and make healthier diet options affordable and easily
accessible. The department especially focuses on poor popu-
lations and children. Both of these groups often have limited
options for what they can eat and where they can live.
WHO’s Department of Nutrition for Health and
Development also promotes healthy diets. It helps nations
develop effective national nutrition policies and programs.
The department also works with food industry companies to
lower portion sizes and to reduce the fat, sugar, and salt con-
tent of processed foods.
Diabetes
Diabetes is a chronic disease that occurs when the pancreas no
longer produces enough insulin or when cells stop respond-
ing to the insulin that the body produces. When the body
digests foods that contain carbohydrates (sugars and starches),
it produces a sugar known as glucose. Blood carries glucose
throughout the body, supplying cells with the energy that they
need to work properly. Insulin is a chemical that is produced
by the pancreas, an organ located near the stomach. Insulin
causes a chemical reaction that allows glucose carried in the
bloodstream to flow into cells. When the pancreas does not
produce enough insulin or when cells no longer respond to
insulin, glucose remains in the bloodstream.
The body reacts to higher glucose levels in the blood by
drawing water out of cells. The water helps the body expel the
excess glucose through urine. Body cells become dried out
and become starved for energy, triggering thirst and hunger
cravings. To provide energy for cells, the body tries to convert
fats and proteins to glucose. This leads to a life-threatening
condition when acidic compounds called ketones build up in

the blood.
There are two types of diabetes. Type 1 diabetes occurs when
the pancreas does not produce enough insulin. It usually devel-
ops by the teen years. Without the daily administration of insulin,
Type 1 is fatal. Type 2 diabetes occurs when the body does not
use insulin effectively. About 90 percent of diabetics worldwide
have Type 2, which primarily arises as a result of excess body
weight and physical inactivity. It usually affects adults, but obese
children are now being diagnosed with the disease.
WHO estimates that more than 180 million people world-
wide suffer from diabetes. It projects that, by 2030, the number
of diabetics may double. More than one million people die
from diabetes each year. Nearly 80 percent of these deaths
occur in low- and middle-income countries. Almost half of the
people who die from diabetes are younger than 70 years old.
Diabetes causes many serious health problems and doubles
a person’s risk of dying. Diabetes can damage the heart and
kidneys. About 70 percent of diabetics die from heart disease,
stroke, or kidney failure. Diabetes can damage small blood
vessels in the retina, leading to blindness. Research has shown
that, after 15 years of diabetes, about 1 in 50 diabetics becomes
blind. About 1 in 10 develops a serious impairment of their
sight. Diabetes can also damage nerves, causing pain, numb-
ness, or weakness in the feet and hands. Reduced blood flow
can lead to amputations, particularly of the feet and legs.
Symptoms of diabetes include frequent urination, slug-
gishness, excessive thirst, and hunger. To help prevent Type 2
diabetes and its many threats to good health, people should:
• maintain a healthy body weight.

• engage in physical activity.
• have regular blood tests, which aid in diagnosing the
disease at an early stage.
• stop using tobacco products.
Through its Diabetes Program, WHO supports countries

in adopting effective measures to detect, prevent, and control
diabetes. It provides scientific guidelines for diabetes prevention
and develops standards for diabetes care. The Diabetes Program
also draws attention to the health threats posed by diabetes, par-
ticularly through its partnership with the International Diabetes
Federation. The two organizations sponsor World Diabetes
Day, held each November 14 to raise awareness of diabetes. The
Diabetes Program supports research and statistical studies on
the disease and its risk factors. For example, one research proj-
ect assessed how increased rates of obesity worldwide would
affect the number of people with diabetes.
Asthma and Other Respiratory Disorders

Asthma is a long-lasting inflammatory disease of the air pas-
sages to and from the lungs. An inflammation of the lining of
the bronchial tubes causes them to swell, reducing the flow
of air into and out of the lungs. The narrowing of the airways
results in wheezing, shortness of breath, and gasping for air.
The inflammation sometimes stops spontaneously and can
also be treated with a wide range of medications. Over time,
the repeated inflammations make the airways particularly
sensitive to cold air, dust, pollutants, and even stress. Similar
respiratory disorders include chronic obstructive pulmonary
disease, respiratory allergies, occupational lung diseases, and
pulmonary hypertension.
About 300 million people worldwide suffer from asthma.
More than 200 million people have chronic obstructive pulmo-
nary disease and other chronic respiratory ailments. Asthma is
the most common chronic disease among children. Compared
with other chronic diseases, it has a low fatality rate. Most
asthma-related deaths occur in low-income and lower-middle-
income countries. Asthma can impair a person’s daily activities
for his or her entire life, however, and can cause such health
problems as sleeplessness and constant fatigue.
The causes of asthma are not completely understood.

Researchers believe that hereditary factors combine with envi-
ronmental factors either to cause allergic reactions or to irritate
the airways. Irritants include such inhaled substances as air
pollution, pollen, dust mites, pet dander, mold, tobacco smoke,
and chemicals. Intense emotions, such as anger and fear, and
certain types of medicines (including aspirin) can trigger
asthma attacks.
The severity and frequency of asthma symptoms vary
among patients. Asthma attacks can occur several times a day
or much less often. The factors that trigger asthma attacks
also vary among patients. A cure has yet to be discovered,
but asthma can be controlled. Medications can relieve short-
term symptoms, such as wheezing. To control the underlying
inflammation of the lining of the bronchial tubes, patients can
take additional medication. They can also control their asthma
by avoiding specific triggers.
Through its Chronic Respiratory Diseases Program, WHO
coordinates international efforts to prevent and control asthma
and other chronic respiratory disorders. It supports the efforts
of member nations to reduce disability and premature death
related to respiratory diseases. The program gathers informa-
tion and statistics on respiratory diseases. It provides advice on
establishing national prevention programs to reduce the level of
exposure to common risk factors, particularly air pollution and
tobacco smoke. The program also gives guidance on setting up
strategies that provide affordable treatments and medications
to patients with chronic respiratory diseases. Along with its
international partners in the Global Alliance Against Chronic
Respiratory Diseases, WHO helps low- and middle-income
countries provide chronic respiratory-disease health services.
Other Chronic Diseases and Injuries

WHO works to prevent and control other chronic diseases.
Many types of chronic diseases, ranging from musculoskeletal
As of 2002, accidental injuries were blamed for the deaths of 1,000

children per week in Vietnam. The Helmets for Kids program has dis-
tributed helmets to 150,000 children in 100 schools. Here, film star
and Road Safety Goodwill Ambassador Michelle Yeoh opens the cer-
emony for the start of the Decade of Action for Road Safety march
in Ho Chi Minh City, Vietnam, in October 2008.
and oral disorders to digestive and skin diseases, account for

about 9 percent of all deaths worldwide each year. WHO pro-
grams, such as the Global Oral Health Program, work to pre-
vent and control specific chronic diseases. WHO teams are also
dedicated to the prevention of blindness and visual impairment
and deafness and hearing impairment.
Accidents and injuries kill more than 5 million people each
year, accounting for 9 percent of all deaths. Traffic accidents,
poisoning, drownings, falls, burns, and various forms of vio-
lence (acts of war and assaults) are major threats in all nations.
Survivors often suffer temporary or permanent disabilities.
WHO’s Department of Violence and Injury Prevention and
Disability collects and analyzes data on accidents and injuries.

It advises member nations on methods to build and improve
health care and support services for victims of accidents and
injuries. The rise in car ownership in rapidly developing coun-
tries, such as China and India, has caused the annual number of
traffic fatalities to soar. In response, the department works with
nations to design programs to prevent traffic deaths and inju-
ries, including WHO’s Helmet Initiative. The Helmet Initiative
promotes the use of helmets as a way to prevent head injuries in
bicycle and motorcycle accidents. The department also works to
improve global emergency care and rehabilitation services.
7
Ensuring Global
Health
WHO’s many departments and programs are dedicated
to ensuring global public health. As part of that effort, the orga-
nization administers international health regulations that pro-
tect the world’s people from infectious diseases. WHO’s member
nations have agreed to comply with a set of international health
rules that help prevent the spread of diseases around the world.
WHO has emergency-response units that provide assistance
with epidemics and humanitarian health crises. It can offer
immediate support and expertise when major public health
emergencies arise. These units include WHO’s Strategic Health
Operations Center, the Global Outbreak Alert and Response
Network, the Health Action in Crises program, and the Disease
Control in Humanitarian Emergencies program.
7
International Health Regulations

WHO’s International Health Regulations are a set of laws that
help nations work together to prevent the spread of diseases
and other health risks between countries. The World Health
Assembly adopted the original regulations, known as Inter-
national Sanitary Regulations, in 1951. These original regu-
lations updated various international sanitary rules that had
been adopted since the mid-1800s. They also brought together
all of the existing rules of public health.
The 1951 regulations focused on monitoring and control-
ling six serious infectious diseases—cholera, plague, relaps-
ing fever (a bacterial infection), smallpox, typhus, and yellow
fever. The regulations required governments to notify WHO if
an outbreak of any of these six diseases occurred within their
borders. The 1951 rules also provided conditions under which
vaccinations could be required as a condition for a person to
enter a country. For example, many countries required (and
still require today) visitors arriving from a country where yel-
low fever was present to show proof that they had received
a yellow fever vaccination. Because modern modes of trans-
portation allowed diseases to spread more easily, the 1951
regulations provided sanitary rules for all forms of transporta-
tion—ships, airplanes, trains, and motor vehicles. For example,
one rule provided guidance on effective methods to rid ships
of rats. (Rat fleas can transmit diseases like typhus and plague
to humans.)
In 1969, the World Health Assembly revised these regula-
tions and renamed them the International Health Regulations.
The 1969 rules focused on preventing the spread of only four
diseases: cholera, plague, smallpox, and yellow fever. Countries
were no longer required to notify WHO of outbreaks of relaps-
ing fever or typhus. Minor modifications to the regulations
were made in 1973 and 1981.
Ensuring Global Health 99
2005 International Health Regulations

Representatives to the World Health Assembly recognized
that the expansion of globalization increased the risks to
human health. In 2005, the assembly approved a major over-
haul of the International Health Regulations. Rapid growth
in international travel and trade increased the likelihood that
diseases could spread quickly around the world. Global trade
increased the potential for food-borne diseases spreading
beyond national borders. It also boosted the potential for con-
taminated drugs and other goods to be shipped worldwide.
The 2005 regulations went into effect in 2007. They
established new sets of rules in three key areas. The first set
required countries to improve their monitoring and reporting
of public health events, such as disease outbreaks. The second
set provided countries with guidelines to strengthen their abil-
ity to respond to public health events. The third set focused
on helping countries expand their support of WHO’s existing
emergency-response programs.
The new rules required international notification for four
diseases: polio, SARS, smallpox, and cases of influenza caused
by any new subtype. The regulations urged countries to improve
their ability to prevent and control disease outbreaks and also
gave WHO a more direct role in investigating and stopping
outbreaks. The rules empowered WHO to work closely with
nations to make sure that they have the skills and personnel to
meet the International Health Regulations focused on diseases.
WHO is now responsible for providing disease-control training
and expertise to countries that need such help.
New scientific evidence shows that the best way to prevent
diseases from crossing borders is to make a rapid public health
response at the sources of diseases. Public health measures
applied at international shipping ports, international airports,
and border crossings can further reduce the risk of disease
spread. The 2005 regulations seek to increase protections at

national borders without making unnecessary or excessive
restrictions on trade and travel.
The 2005 rules provide countries with immediate guidance
on how to assess, respond, and control public health risks as
they arise. During an international public health emergency,
WHO may recommend short-term measures that affect or
restrict international trade or travel. For example, it may advise
a country to require travelers arriving at its borders to undergo
a basic health examination or present proof of vaccination
against a specific disease.
Member State Obligations

The 2005 regulations require countries to notify WHO about
any event within their borders that may be a Public Health
Emergency of International Concern (PHEIC). Countries
must also respond to WHO requests asking for verification
of information about these events. These two rules enhance
information sharing between member nations and WHO.
They also help the organization to ensure effective interna-
tional collaboration to prevent public health emergencies or
to contain outbreaks. In many cases, WHO will inform other
countries affected by the specific public health event.
WHO’s efforts in support of the International Health
Regulations have increased the understanding in countries of
the importance of early notification of outbreaks or events.
Member states have become more willing to contact WHO
when a possible PHEIC is suspected. They know that they will
receive timely assistance from WHO and other organizations
and nations.
Under the International Health Regulations, countries
must notify WHO within 24 hours in the event of a PHEIC,
which is a significant public health event that meets two stan-
dards. It must constitute a public health risk to other countries
through the international spread of disease, and it must have

the potential to require a coordinated international response.
Several factors determine whether a public health event is a
PHEIC. The issues involved are:
• How severe is the potential public impact?

• Where and when is the event occurring?
• How close is the event to an international border?
• How quickly will the disease spread?
• How is the disease transmitted?
• How severe would potential restrictions to travel and
trade be?
Examples of events that may constitute a PHEIC are out-

breaks of pneumonic plague, West Nile fever, meningitis, and
significant chemical or radiological accidents.
Through the PHEIC program, WHO can provide the
world with timely notifications of serious public health events.
Working with the country involved, WHO can assess the risk
to global public health and inform other countries of those
risks. This process reduces the likelihood that a disease will
spread internationally.
The 2005 regulations set up a new, more effective system
of notification. Each country must have a special office dedi-
cated to administering the new rules. These national offices
must be able to respond 24 hours a day, 7 days a week to public
health events within their borders. These offices have greatly
improved the capability of nations to detect and respond to
public health events.
To help prevent the spread of diseases between countries,
WHO member nations have agreed to set up health-control
measures at international borders. The International Health
Regulations require countries to conduct health inspections
at international seaports and airports, as well as at major
In 2003, the rapid spread of SARS in southern Asia required a quick

solution at international borders. Singapore’s Defense Science and
Technology Agency created the thermal-imaging scanner, which reads
body temperatures and detects passengers with high fevers, the most
prominent symptom of SARS. The images of those with fevers show up
red and these passengers are taken aside for further health checks.
ground crossings. Nations must also report to WHO any evi-

dence of a public health risk that they have detected in other
countries. A country may become aware of a risk because
of potentially infected travelers or contaminated goods that
either arrive at its border or have been transported abroad.
For example, if a person showing symptoms of yellow fever
arrives at an international airport, national health authorities
will inform WHO of the person’s origin. If a country discovers
that cargo shipped from one of its ports may present a health
risk (tainted food, for example), it must inform WHO of the
ship’s destinations.
By agreeing to be bound by the 2005 regulations, mem-

ber nations receive several benefits. WHO provides advice
and support that improves the ability of countries to detect,
report, assess, and respond to public health emergencies.
WHO helps low- and middle-income countries obtain the
funds needed to meet their responsibilities under the regu-
lations. WHO also provides timely, essential public-health
assistance to countries that experience disease outbreaks and
other serious public-health events. The organization also
helps protect nations by providing up-to-date information
about public-health risks worldwide.
WHO Obligations
Besides establishing obligations for WHO’s member nations, the
2005 regulations also spelled out the organization’s obligations.
WHO must designate International Health Regulation (IHR)
contacts in its country offices, regional offices, and Geneva
headquarters. To detect serious public health risks, WHO must
constantly monitor global public health and gather evidence
about diseases worldwide. The regulations give WHO the sole
authority to determine whether a particular event constitutes a
PHEIC. WHO must offer technical assistance and other guid-
ance to help nations prepare for a PHEIC within their borders.
This assistance will help countries develop, strengthen, and
maintain their ability to detect and respond to public health
risks and emergencies. WHO also has the responsibility of
updating the regulations to keep them current and based on the
latest scientific knowledge. Finally, whenever a dispute involv-
ing international public health arises, the IHRs authorize WHO
to negotiate a settlement between the conflicting parties.
Challenges
The 2005 regulations present many challenges to WHO and its
member nations. Both WHO and the countries need adequate
budgets and staff to implement the required programs. WHO’s
major ongoing challenge is to help lower-income countries

develop the technical capacities to fulfill their obligations. Many
countries lack the ability to detect and report new diseases or
events at the primary health-care level. Hospitals and medical
specialists in many countries also lack the ability to confirm
a diagnosis of some infectious diseases, and many national
health agencies do not have the means to carry out appropriate
measures to control the spread of infectious diseases.
Emergency and Humanitarian Actions

Dangerous epidemics and the emergence of new infectious
diseases can occur anywhere at any time. In many cases,
they overwhelm national health systems, particularly in low-
income countries. They sometimes cause many deaths and
threaten a country’s economic and political stability. Epidem-
ics can also spread quickly to other countries. No single coun-
try or international agency can respond effectively to these
major public health emergencies. To help countries facing a
potential international public health emergency, WHO has
forged partnerships and created programs to ensure that the
countries have immediate access to appropriate resources and
health experts.
In 2005, the United Nations designated WHO as the head
of the Global Health Cluster. This group of UN organizations
and other international agencies coordinates the response to
health crises by all parties involved in international public
health. As a result of this new leadership function, WHO has
strengthened its role in dealing with the health issues that arise
during natural disasters, warfare, and other emergencies. It has
upgraded its capacities for rapid response, recovery efforts, and
emergency preparedness.
WHO’s Strategic Health Operations Center is the hub of
WHO’s global-response efforts. During disease outbreaks and
humanitarian emergencies, the center coordinates the flow of
information between WHO, its international partners, and
member nations. WHO created the center in 2004. It faced its
Many people in developing countries live in remote places

where the nearest medical facilities are located hours or
even days away from a village. People without access to basic
health-care services die from preventable and treatable dis-
eases like malaria, diarrhea, and respiratory tract infections.
WHO distributes emergency health kits containing supplies
and medicines that a typical population of 10,000 would need
over a three-month period.
first crisis that December when a devastating tsunami struck

Indonesia, Thailand, and other countries in Southeast Asia.
The following year, the center coordinated the international
health response to Hurricane Katrina in the United States and
to an earthquake in Pakistan. The center works with three
other WHO agencies to respond to international public health
emergencies. It also provides advice to WHO regional and
country offices, UN agencies, and international organizations
on how to build emergency operation centers. It also takes part
in practice exercises to prepare for global health emergencies.
The Global Outbreak Alert and Response Network

To coordinate responses to international disease outbreaks,
WHO helped create the Global Outbreak Alert and Response
Network in 2000. This alliance of international agencies and
private enterprises helps countries control diseases by pro-
viding operational assistance. The network coordinates the
delivery of medical supplies and other support to affected
countries. Through the network, WHO and its partners have
responded to more than 50 international disease events in
more than 40 countries. They provided the assistance of more
than 400 public health experts.
When faced with a potential public health emergency, the
Global Outbreak Alert and Response Network investigates the
event and determines whether it is likely to become a threat to
international health. If the network decides that international
action is needed, it assigns a project manager to coordinate the
response. The project manager makes sure that appropriate
assistance reaches the affected country rapidly. For example,
when the SARS epidemic struck in 2003, the network assembled
and sent an international team to China and Vietnam. The
team included experts in respiratory diseases and epidemiol-
ogy. The network worked with many partners to respond to the
crisis. The U.S. Centers for Disease Control and Prevention, the
United Kingdom’s Public Health Laboratory Service, Australia’s
Biosecurity Cooperative Research Center, Germany’s Robert

Koch Institute, and the nonprofit group Médecins Sans Frontières
(Doctors Without Borders) were among the organizations that
worked with WHO to deal with the epidemic.
In 2008, the network responded to a wide range of public
health emergencies worldwide. These included:
• bird flu outbreaks in China, Indonesia, Vietnam,

Pakistan, Bangladesh, and Egypt.
• Rift Valley fever outbreaks in Sudan and Madagascar.
• yellow fever outbreaks in Brazil, Paraguay, Guinea, the
Ivory Coast, Burkina Faso, Central African Republic,
and Liberia.
• a dengue fever outbreak in Brazil.
• an enterovirus outbreak in China.
• a polio outbreak in Nigeria.
• cholera outbreaks in Iraq and Guinea Bissau.
• a melamine-contaminated powdered infant formula
crisis in China.
• a previously unknown virus in the Arenaviridae family
in South Africa and Zambia.
To prepare in advance for public health emergencies, the

Global Outbreak Alert and Response Network has created a set
of emergency-response procedures. These include standards
on managing the flow of information, supplies, and other
resources for field teams. The network also helps countries
build up health systems to prepare in advance for epidemics.
These measures include establishing medical laboratories, set-
ting up early warning systems for infectious diseases common
in the country, and starting training programs.
Health Action in Crises

Natural and political crises threaten the lives and health of mil-
lions of people worldwide. These crises include earthquakes,
hurricanes, wars, and civil unrest. WHO’s Health Action in

Crises program works with international partners and member
countries to help local communities respond to and recover
from humanitarian emergencies. Emergencies of this magni-
tude often overwhelm local and national health systems, par-
ticularly in developing countries. The primary goal of Health
WHO Reacts to a
Humanitarian Crisis
On May 2, 2008, a powerful cyclone struck the nation of Myanmar

(formerly Burma). Cyclone Nargis slashed through Yangon, the
nation’s largest city, and the country’s low-lying delta region. High
winds and widespread flooding left more than 150,000 people dead
or missing. The worst natural catastrophe in Myanmar’s history dis-
rupted the lives of as many as 2.5 million people. Twelve-year-old
Leh Ler Shee survived by clinging to a tree after a surge of water
destroyed the house he was in. He recalled, “I saw many dead bodies,
dead cattle, and debris everywhere. I went back home and saw that
my house had collapsed. I tried to find my mother but I couldn’t.”*
The World Health Organization immediately sprang into
action. Its country office in Yangon handled the initial response.
The Health Action in Crises program and WHO’s Southeast Asia
Regional Office coordinated efforts to send supplies and emer-
gency-response teams to the devastated country. More than 140
WHO staff members soon arrived to assess the public health
situation and to help coordinate the health response. With the
support of Italy, Health Action in Crises provided 10 emergency
health kits, which had enough supplies to provide essential care to
300,000 people for three months. WHO and the governments of
Norway and Denmark donated nearly $500,000 to buy urgently
needed medical supplies.
Action in Crises is to lower the number of deaths, reduce the

amount of suffering, and ensure the health of populations.
When a crisis occurs, Health Action in Crises works with
the UN Executive Committee on Humanitarian Affairs and the
UN humanitarian coordinator assigned to the event. The coor-
dinator oversees the humanitarian efforts of WHO and other
The storm destroyed health-care facilities and medications

and killed or dislocated health-care workers. As survivors fled the
still-submerged delta region, overcrowding and the lack of safe
water and adequate sanitation facilities posed a severe threat to
public health. WHO officials became concerned about the risk of
infectious diseases— particularly cholera, malaria, and tuberculo-
sis—spreading through the country.
Worries about epidemics soon faded. Only a few dozen cases
of dengue fever and higher-than-normal levels of diarrheal dis-
eases were reported. Richard Garfield of the Health and Nutrition
Tracking Service, an international partnership hosted by Health
Action in Crises, observed, “The most important thing that . . .
WHO took part in was an assessment of the needs in the region,
visiting 291 villages throughout this very remote region. . . . We
have never had this kind of assessment after a major disaster, so
we know now what the needs are and how they have changed
since the disaster.”**
* Nattha Kennapan, “Child-Friendly Spaces Provide Refuge for Cyclone-

Affected Children in Myanmar,” UNICEF. June 5, 2008. Available online at
www.unicef.org/infobycountry/myanmar_44377.html.
** Transcript of WHO podcast, July 28, 2008. Available online at www.who.int/
mediacentre/multimedia/podcasts/2008/transcript_40/en/index.html.
international organizations. Health Action in Crises makes

sure that there is an adequate response to health issues during
the crisis. Following the crisis, the program helps the country
rebuild its health systems and advises on how to maintain
those systems. It also helps countries improve their ability to
respond to future disasters. Funds for the program’s activities
come from the World Health Assembly and the UN’s Central
Emergency Response Fund.
In 2008, Health Action in Crises helped supply emergency
medicine and equipment to victims of a flood that struck India
and Nepal. More than 3.4 million people were affected when
the waters of the Kosi River overflowed its banks. Samlee
Plianbangchang, WHO’s regional director for Southeast Asia,
noted, “WHO’s assistance includes supplying emergency medi-
cines and equipment for 180,000 people, supporting disease
surveillance and child immunization campaigns and ensuring
safe drinking water.”16
Program on Disease Control

in Humanitarian Emergencies
WHO’s program on Disease Control in Humanitarian Emer-
gencies responds to humanitarian emergencies in which
large numbers of people have been displaced. When natural
disasters strike, people often move temporarily to places
that are unable to handle the influx of people. Inadequate
food and shelter, unsafe drinking water, and poor sanitation
often increase the risk of the spread of infectious diseases.
Health officials can encounter high rates of respiratory infec-
tions, diarrheal diseases, and infectious diseases like measles,
malaria, and tuberculosis.
The program works to reduce the effects of diseases during
humanitarian emergencies and in longer crises, such as civil
wars. Its major focus is to provide technical and operational
support to Health Action in Crises, WHO regional and country
offices, national heath-care agencies, and other UN and inter-
national agencies. It develops guidelines for controlling com-

municable diseases during humanitarian crises. The program
works to strengthen international and local partnerships to be
better prepared for such crises. In 2008, it provided support to
protect the health of populations in 12 conflict-torn countries,
including Afghanistan, Chad, Liberia, Somalia, and Sudan.
8
Health Care for

Everyone
In 2008, WHO celebrated its sixtieth anniversary. To
chronicle its history since 1948, the organization produced
books, videos, and podcasts and sponsored photo exhibits,
seminars, and other events. All of these activities showed
the significant impact of WHO’s efforts over the decades to
improve global public health. The organization also used the
milestone to draw attention to the important challenges that
the organization continues to face and its plans to meet those
challenges in the future.
WHO has achieved many notable successes, such as
the eradication of smallpox, its rapid responses to count-
less epidemics, and its effective programs that prevent polio,
measles, and other diseases. Its efforts to improve underlying
factors that affect health—such as the environment, diet and
112
Introduction to the World
Health
Health
Care Organization
for Everyone 113
nutrition, and tobacco control—have achieved mixed results.

These undertakings have obligated the organization to deal
with such complex issues as poverty, globalization, human
rights, and social justice.
WHO remains the world’s foremost source of public
health information. It shares its scientific, technical, training,
and administrative knowledge with its member nations and
other international organizations. These efforts help member
nations to prevent, treat, and cure diseases and other threats
to public health. WHO works to prevent epidemics, respond
to public health emergencies, and assist in achieving the UN’s
Millennium Development Goals. It sponsors public health con-
ferences, publications, and outreach programs. Perhaps most
importantly, as two public health scholars have noted, WHO
is the “world’s health conscience.”17 It serves as an advocate for
the poor and the powerless who desperately need health care. It
seeks to ensure that everyone in the world has access to quality
health care.
WHO’s efforts to improve health around the world involve
more than employing medical science and public health policy.
Its work touches on issues of economics, politics, environ-
mentalism, and culture. Perhaps the most difficult challenges
facing global public health—and, therefore, WHO—is poverty.
Roughly 6.7 billion people now inhabit the planet. More than
2.5 billion of them live on less than $2 a day. They struggle to
pay for food, clothing, shelter, and other essentials. Many of the
world’s poor receive little or no health care.
More than half of the world’s nations are developing coun-
tries. Poor nutrition, unsafe drinking water, and inadequate
sanitation are common problems in these countries. These
conditions often lead to high rates of disease and death. Many
developing countries lack the financial means to build and
sustain adequate national health systems. These nations suf-
fer from a shortage of medicines and a lack of technology
Outbreaks of emerging and epidemic-prone diseases are increasing, due

to rapid urbanization, environmental mismanagement, the trading of food,
and the misuse of antibiotics. WHO has answered the world’s call to
collectively defend itself against health security threats and participates
in reforms to improve its efficiency and effectiveness so that all people
have access to basic health services. Above, a cheer team participates in
a rally celebrating Taiwan’s removal from the SARS affected-area list by
WHO in July 2003.
and other medical equipment. Many also have too few or

poorly trained health-care workers. Poverty and health often
link together in a downward spiral. Poor public health results
in less economic output and lower national incomes. Low
Health Care for Everyone 115
national incomes hinder countries in building and maintaining

adequate health-care systems. Improving health in developing
countries can improve their ability to expand their economies
and strengthen their health-care systems. Strong health-care
systems will produce healthier citizens who can work, attend
school, and create more prosperous lives for themselves.
WHO also faces several organizational challenges. The
public health needs of WHO’s member nations vary greatly.
These differences have created a rift between low- to middle-
income members and high-income members. Developing
countries want WHO to address their health needs, particu-
larly the strengthening of primary health-care systems and the
improvement of access to affordable medications and medical
technologies. Wealthier members have questioned the appro-
priateness of WHO adopting these roles.
In carrying out its mission, WHO has also become increas-
ingly dependent on outside groups. It works with other UN
agencies and a wide range of international nongovernmental
organizations to develop global public health research, policies,
and programs. WHO now relies less on funding from member
nations and more on funding from corporations and charitable
foundations. The need to collaborate with other organizations
expands WHO’s reach and improves its effectiveness. It also
weakens its independence and neutrality and slows its response
to health issues.
WHO faces many health-related challenges. The threat
of new diseases, such as Ebola and SARS, remains a constant
concern. New strains of known infectious diseases have also
emerged. Many are resistant to the drugs commonly used to
treat the disease, making uncontrollable epidemics a continu-
ing threat. Drug companies are developing few antibiotics to
battle infections. Instead, they are focusing their research and
development on more profitable products, such as drugs to
treat symptoms of chronic diseases and nonessential medica-
tions to treat conditions like baldness.
Lifestyle changes in developing countries, with people con-

suming foods higher in sugar and fat and using more tobacco
products, have increased health risks in those countries. Armed
conflicts and natural disasters interfere with WHO programs
and lead to epidemics and other health problems. The growth
of threats to healthy environments, such as pollution and global
warming, threaten the well-being of people worldwide.
WHO staff in a wide range of departments, programs, and
teams work around the world to improve global health. WHO
microbiologists monitor changes in virus subtypes. WHO doc-
tors help develop new drugs. WHO researchers study links
between health and diet. Employees at WHO country offices
deliver vaccines to war-torn regions. These are only a few of the
people at WHO striving to make the world healthier.
Since its inception, WHO has earned an excellent inter-
national reputation. It makes a unique contribution to global
public health and the lives of people worldwide. In carrying
out its mission to achieve “the attainment by all peoples of
the highest possible level of health,”18 WHO will continue to
strengthen the world’s united defense against epidemics and
other risks that threaten global public health. It will continue
to help countries build and sustain national health-care sys-
tems. In 2008, Margaret Chan, WHO’s director-general, reas-
serted the organization’s resolve to continue to advocate for fair
access to essential health care. She declared, “Health systems
will not automatically gravitate towards greater fairness and
efficiency. . . . Our world will not become a fair place for health
all by itself.”19 All of WHO’s efforts will continue to be based
on the belief that all human life matters and that everyone
deserves good health.
Chronology
1300s Venice quarantines visitors and vessels from abroad.
1830s The first sanitary board is founded in Alexandria,
Egypt.
1851 The first international sanitary conference is held in
Paris, France.
1892 The first international sanitary rules are approved.
1902 The world’s first global health organization, the
International Sanitary Bureau, is founded.
1918 A global campaign to eradicate yellow fever is launched.
1920 The Health Organization of the League of Nations is
founded.
1946 The United Nations Economic and Social Council
proposes a specialized UN agency for health.
1948 The World Health Organization begins its operations.
The first World Health Assembly is held.
1951 New International Sanitary Regulations are adopted.
1959 The first World Health Situation Report is published.
1969 International Sanitary Regulations are revised and
renamed the International Health Regulations.
1977 The World Health Assembly adopts Health for All by
the Year 2000 resolution.
1980 WHO announces the eradication of smallpox.
1987 The Global Program on AIDS is created.
1995 The first World Health Report is published.
WHO launches its DOTS strategy for tuberculosis.
2000 WHO establishes the Global Outbreak Alert and
Response Network.
The UN adopts Millennium Development Goals.
117
118 Chronology
2003 The World Health Assembly adopts the Framework

Convention on Tobacco Control.
WHO coordinates the international response to the
SARS outbreak.
2004 The World Health Assembly adopts the Global
Strategy on Diet, Physical Activity, and Health.
2005 International Health Regulations are substantially
revised.
2008 WHO celebrates its sixtieth anniversary.
Notes
Introduction
1. “SARS Outbreak Contained Worldwide.” WHO press
release, July 5, 2003. Available online at www.who.int/
mediacentre/news/releases/2003/pr56/en/.
Chapter 1
2. Constitution of the World Health Organization. Available
online at www.who.int/governance/eb/constitution/en/
index.html.
3. UN Office for the Coordination of Humanitarian Affairs,
Integrated Regional Information Networks. “AFRICA:
Low Cost Meningitis Vaccine Developed,” March 4, 2008.
Available online at www.irinnews.org/report.aspx?Report
ID=77105.
4. World Health Organization. Working for Health: An
Introduction to the World Health Organization. Geneva,
Switzerland: WHO Press, 2007, p. 7. Available online at
www.who.int/about/brochure_en.pdf.
Chapter 2
5. Paul De Kruif, Microbe Hunters. New York: Harcourt,
2002, p. 92.
6. UN General Assembly, Prevention and Control of Ac-
quired Immunodeficiency Syndrome (AIDS), Resolution
42/8 (1987).
Chapter 3
7. World Health Organization. Working for Health: An
Introduction to the World Health Organization. Geneva,
Switzerland: WHO Press, 2007, p. 7. Available online at
www.who.int/about/brochure_en.pdf.
119
120 Notes
Chapter 4
8. UN General Assembly. United Nations Millennium Dec-
laration, September 9, 2000.
9. WHO/UNICEF. Global Plan for Reducing Measles Mor-
tality 2006–2010. Geneva, Switzerland: World Health
Organization, 2006, p. 2.
10. World Health Organization. Health-Promoting Schools: A
Healthy Setting for Living, Learning, and Working. Geneva,
Switzerland: World Health Organization, 1998, p. 6. Avail-
able online at www.who.int/school_youth_health/media/
en/92.pdf.
11. World Health Organization—Gender, Women, and Health
Program. “Integrating Gender Analysis and Actions into
the Work of WHO.” Available online at www.who.int/
gender/mainstreaming/integrating_gender/en/index.html.
Chapter 5
12. Stop TB Partnership. “Bam! Kapow! Figo Scores a Goal
Against Tuberculosis in a New Comic Book,” July 24, 2008.
Available online at www.stoptb.org/figo/News.asp.
Chapter 6
13. World Health Organization. World Health Statistics 2008.
Geneva, Switzerland: World Health Organization, 2008,
p. 29.
14. World Health Organization. Fight Against Cancer: Strate-
gies That Prevent, Cure, and Care. Geneva, Switzerland:
World Health Organization, 2007, p. 4.
15. World Health Organization. WHO Report on the Global
Tobacco Epidemic. Geneva, Switzerland: World Health
Organization, 2008, p. 7.
Notes 121
Chapter 7
16. “WHO Chips in to Help Flood Victims in Bihar.” Times of
India, September 6, 2008. Available online at timesofindia.
indiatimes.com/articleshow/msid-3453223,prtpage-1.cms.
Chapter 8
17. Kent Buse and Gill Walt, “Globalisation and Multilateral
Public-Private Health Partnerships: Issues for Health
Policy” in Health Policy in a Globalizing World, Kelley Lee,
ed. New York: Cambridge University Press, 2002, p. 56.
18. Constitution of the World Health Organization. Avail-
able online at www.who.int/governance/eb/constitution/
en/index.html.
19. Margaret Chan, “Global Action to Strengthen Health
Systems,” keynote address at the G8 Tokyo summit,
November 3, 2008. Available online at www.who.int/dg/
speeches/2008/20081103/en/index.html.
bibliography
Asia Pacific Leadership Forum on HIV/AIDS and Development.
Portraits of Commitment: Why People Become Leaders in AIDS
Work. Bangkok, Thailand: Asia Pacific Leadership Forum on
HIV/AIDS and Development, 2007. Available online. URL:
http://www.aplfaids.com/documents/SA_Portraits_book.pdf.
Breslow, Lester et al., eds. The Encyclopedia of Public Health.
New York: Macmillan, 2001.
Burci, Gian Luca and Claude-Henri Vignes. World Health
Organization. The Hague, The Netherlands: Kluwer Law
International, 2004.
Buse, Kent and Gill Walt. “Globalisation and Multilateral
Public-Private Health Partnerships: Issues for Health Policy”
in Health Policy in a Globalizing World, Kelley Lee, ed. New
York: Cambridge University Press, 2002.
Chan, Margaret. “Global Action to Strengthen Health Systems,”
keynote address at the G8 Tokyo summit, November 3, 2008.
Available online. URL: http://www.who.int/dg/speeches/2008/
20081103/en/index.html.
De Kruif, Paul. Microbe Hunters. New York: Harcourt, 2002.
Fidler, David R. “The Globalization of Public Health: The First
100 Years of International Health Diplomacy” in Bulletin of
the World Health Organization. Geneva, Switzerland: World
Health Organization, 2001.
Jaret, Peter. Impact: Dispatches from the Front Lines of Global
Health. Washington, D.C.: National Geographic, 2003.
Kennapan, Nattha. “Child-Friendly Spaces Provide Refuge for
Cyclone-Affected Children in Myanmar,” UNICEF. June 5,
2008. Available online. URL: http://www.unicef.org/infoby
country/myanmar_44377.html.
Lee, Kelley. Historical Dictionary of the World Health Organi-
zation. Lanham, Md.: Scarecrow Press, 1998.
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Bibliography 123
———. World Health Organization. New York: Routledge, 2008.

Lerner, K. Lee and Brenda Wilmoth Lerner, eds. World of
Microbiology and Immunology. Farmington Hills, Mich.:
Gale, 2002.
Piddock, Charles. Outbreaks: Science Seeks Safeguards for Global
Health. Washington, D.C.: National Geographic, 2008.
“SARS Outbreak Contained Worldwide.” WHO press release,
July 5, 2003. Available online. URL: http://www.who.int/
mediacentre/news/releases/2003/pr56/en/.
Sixty-First World Health Assembly. Agenda item 11.10,
WHA61.4., May 24, 2008, “Strategies to Reduce the Harm-
ful Use of Alcohol.” Available online. URL: http://www.who.
int/nmh/WHA%2061.4.pdf.
Stop TB Partnership. “Bam! Kapow! Figo Scores a Goal Against
Tuberculosis in a New Comic Book,.” Press release dated July
24, 2008. Available online. URL: http://www.stoptb.org/figo/
News.asp.
Tibayrenc, Michel. Encyclopedia of Infectious Diseases. Hoboken,
N.J.: Wiley, 2007.
Transcript of WHO podcast, July 28, 2008. Available online.
URL: http://www.who.int/mediacentre/multimedia/podcasts/
2008/transcript_40/en/index.html.
United Nations. The Millennium Development Goals Update
2008. New York: United Nations, 2008.
United Nations Department of Economic and Social Affairs.
The Millennium Development Goals Report 2006. New York:
United Nations, 2006.
United Nations General Assembly. United Nations Millennium
Declaration, September 9, 2000.
———. Prevention and Control of Acquired Immunodeficiency
Syndrome (AIDS), Resolution 42/8, October 26, 1987.
124 Bibliography
United Nations Office for the Coordination of Humanitarian

Affairs, Integrated Regional Information Networks. “AFRICA:
Low Cost Meningitis Vaccine Developed,” March 4, 2008.
Available online. URL: http://www.irinnews.org/report.aspx?
ReportID=77105.
“WHO Chips in to Help Flood Victims in Bihar.” Times of India,
September 6, 2008. Available online. URL: http://timesofindia.
indiatimes.com/articleshow/msid-3453223,prtpage-1.cms.
Wide Angle: Birth of a Surgeon: Aaron Brown Interview: Dr.
Margaret Chan. PBS. Available online. URL: http://www.
pbs.org/wnet/wideangle/episodes/birth-of-a-surgeon/aaron-
brown-interview-dr-margaret-chan/1810/.
Wide Angle: Birth of a Surgeon—Midwives in Mozambique. PBS.
Available online. URL: http://www.pbs.org/wnet/wideangle/
episodes/birth-of-a-surgeon/introduction/747/.
World Health Organization. Constitution of the World Health
Organization. Available online. URL: http://www.who.int/
governance/eb/constitution/en/index.html.
———. Fight Against Cancer: Strategies That Prevent, Cure,
and Care. Geneva, Switzerland: World Health Organization,
2007.
———. Gender, Women, and Health Program. “Integrating
Gender Analysis and Actions into the Work of WHO.”
Available online. URL: http://www.who.int/gender/main
streaming/integrating_gender/en/index.html.
———. Health-Promoting Schools: A Healthy Setting for Living,
Learning, and Working. Geneva, Switzerland: World Health
Organization, 1998. Available online. URL: http://www.who.
int/school_youth_health/media/en/92.pdf.
———. WHO Report on the Global Tobacco Epidemic. Geneva,
Switzerland: World Health Organization, 2008.
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———. Working for Health: An Introduction to the World Health

Organization. Geneva, Switzerland: WHO Press, 2007.
———. World Health Report 2008. Geneva, Switzerland: World
———. World Health Statistics 2008. Geneva, Switzerland: World
WHO/UNICEF. Global Plan for Reducing Measles Mortality
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further reading
Allman, Toney. Diabetes. New York: Chelsea House, 2008.
Beck-Sague, Consuelo and Caridad Beck. HIV/AIDS. New
York: Chelsea House, 2003.
Bookmiller, Kirsten Nakjavani. The United Nations. New York:
Chelsea House, 2008.
Bozzone, Donna M. Causes of Cancer. New York: Chelsea
House, 2007.
Coleman, William. Cholera. New York: Chelsea House, 2008.
Emmeluth, Donald. Influenza. New York: Chelsea House, 2008.
Finer, Kim Renee. Tuberculosis. New York: Chelsea House, 2003.
———. Smallpox. New York: Chelsea House, 2004.
Hinds, Maurene J. Fighting the AIDS and HIV Epidemic: A
Global Battle. Berkeley Heights, N.J.: Enslow Publishers, 2007.
Marcus, Bernard A. Malaria. New York: Chelsea House, 2003.
Senker, Cath. World Health Organization. Chicago: Raintree,
2004.
Serradell, Joaquima. SARS. New York: Chelsea House, 2003.
Turkington, Carol and Bonnie Lee Ashby. The Encyclopedia of
Infectious Diseases. New York: Facts on File, 2007.
Youngerman, Barry. Pandemics and Global Health. New York:
Facts on File, 2008.
Web sites
Centers for Disease Control and Prevention
http://www.cdc.gov
This site provides reliable, up-to-date health information for
individuals, public health professionals, health-care provid-
ers, researchers and scientists, policy makers, students, etc.
126
Further Reading 127
Roll Back Malaria Partnership

http://www.rollbackmalaria.org
Campaign launched in 1998 by WHO, UNICEF, the UN
Development Program, and the World Bank to provide a
global coordinated approach to fighting malaria.
Stop TB Partnership
http://www.stoptb.org
Established in 2000 to realize the goal of eliminating tuber-
culosis as a public health problem.
The United Nations

http://www.un.org.
International organization that facilitates cooperation in inter-
national law, international security, economic development,
social progress, human rights, and achieving world peace.
The World Bank

http://www.worldbank.org
A bank that provides financial and technical assistance to
developing countries for development programs (bridges,
roads, schools) with the goal of reducing poverty.
UNAIDS (Joint United Nations Program on HIV/AIDS)

http://www.unaids.org
Joint venture of the United Nations members to help the
world prevent new HIV infections, care for people living
with HIV, and lessen the impact of the epidemic.
UNICEF (United Nations Children’s Fund)

http://www.unicef.org.
128 Further Reading
Global organization that provides long-term humanitar-

ian and development assistance to children and mothers in
developing countries.
World Health Organization

http://www.who.int
A specialized agency of the United Nations that acts as the
authority on health.
Picture credits
Page
10: Getty Images 68: Getty Images
13: AP Images 76: Zhao Jiazhi/Xinhua/Landov
19: Jean-Pierre Clatot/Newscom 80: Mike Hutchings/Reuters/
22: Getty Images Landov
24: Getty Images 84: Scheibe/Barker/Newscom
30: AP Images 90: AP Images
38: © Infobase Publishing 95: AP Images
41: AP Images 102: © Romeo Ranoco/Reuters/
46: Newscom Corbis
53: Getty Images 105: AP Images
56: Getty Images 114: Getty Images
64: Getty Images
129
Index
a chloroquine, 74
accidents, 95–96 cholera, 25, 26, 98
Africa, Regional Office for, 42 Chronic Respiratory Diseases
AIDS. See HIV/AIDS Program, 94
alcohol, 36–37 climate change, 63
Americas, Regional Office for, 42 condoms, 72
arsenic, drinking water and, 43, coronaviruses, 9
56 country offices, 43
asthma, 56, 93–94 cowpox, 15
avian influenza, 7–8 Cumbane, Emilia, 59
cyclones, 108
b
bacteria, 77 d
bird flu, 7–8 delegates, role of, 18
blood donation, 48, 67 Department of Control of
BMI. See Body mass index (BMI) Neglected Tropical Diseases,
Board of Health, 25 44–45
body mass index (BMI), 88–91 Department of Ethics, Trade,
body weight, 88–91 Human Rights, and Health
Brundtland, Gro Harlem, 11, 34 Law, 45
Burkina Faso, 18–19 developing countries, 16–17, 32,
Burma, 108 49, 81
diabetes, 39, 44, 91–93
c diarrhea, 54, 55, 63
Cancer Commission, 29 director-general position, 40–41
cancers, 39, 83–88 disease prevention. See Prevention
cardiovascular diseases, 39, 82–83 Doctors Without Borders, 107
Carter Center, 18 donations, 49–50
cesarean sections, 58–59 DOTS (directly observed
Chadwick, Edwin, 24–25 treatment, short-course), 78–79
Chagas’ disease, 44 drinking water, 43, 56, 62–63
challenges, organizational, 48–49, drug-resistance, tuberculosis and,
104, 115–116 79–80
Chan, Margaret, 59, 88, 116 drugs, affordable, 63–64
charters, 30
Chen, Johnny, 7–8, 10 e
Child and Adolescent Health earthquakes, 45, 107–108
and Development program, 56, Eastern Mediterranean, Regional
71–72 Office for, 42
child mortality, 54–58. See also Ebola, 115
Maternal health education, 61–62, 69–70
Children’s Environmental Health emergency relief, 45, 104–111
program, 55–57 environmental sustainability, 55,
China, earthquakes in, 45 62–63
130
Index 131
Ethics, Trade, Human Rights, and health programs, overview of,

Health Law Department, 45 44–45
Executive Board, 18, 39–40 Health Workforce, 45
heart disease, 82–83
f Helmet Initiative, 96
Figo, Luís, 79 HIV/AIDS
flooding, 109 child mortality and, 54, 57
funding, 33–34, 49, 108 education and, 63
overview of, 66–73
g recognition of, 33–34
Garfield, Richard, 109 tuberculosis and, 78
Gender, Women, and Health Hospice Africa-Uganda, 85
Program, 62 humanitarian aid, 104–111
gender equality, 62 hurricanes, 106
General Program of Work reports,
40, 47–48 i
germ theory, 27 IHR contacts. See International
Global Action Plan Against Cancer, Health Regulation contacts
86–87 immune system, defined, 17
Global Advisory Committee on Immunization, Vaccines, and
Vaccine Safety, 45 Biologicals Department, 72
Global Database of Child Growth immunizations. See Vaccines
and Malnutrition, 45 indicators, malaria and, 77
Global Health Cluster, 104 Industrial Revolution, 23–24
Global Immunization Vision and infant mortality. See Child
Strategy, 54–55 mortality
Global Malaria Program, 75 infectious diseases, SARS as, 8–11
Global Oral Health Program, 95 influenza, 28, 99
Global Outbreak Alert and insecticides, 77
Response Network, 106–107 inspections, 101
Global Program on AIDS, 33 insulin, 91–92. See also Diabetes
Global School Health Initiative, international agreements, 26
61 International Diabetes Federation,
global trade, 22–26, 45, 99–100 93
Guinea worm disease, 16 International Health Regulation
(IHR) contacts, 103
h International Health Regulations,
Health Action in Crises, 108–110 31, 98–104
Health and Nutrition Tracking International Monetary Fund, 52
Service, 109 International Office of Public
health care systems, improvement Hygiene, 28–29
of, 47 International Sanitary Bureau,
Health Organization of the 27–28. See also Pan American
League of Nations, 28–29, 41 Health Organization
132 Index
International Sanitary Conference, member countries, 15

26, 28 meningitis, 18–19, 101
International Sanitary Regulations, Meningitis Vaccine Project, 19
31, 98. See also International midwives, 58–59
Health Regulations Millennium Declaration, 51–52, 65
Ivory Coast, 55 Millennium Development Goals
(MDGs)
j child mortality reduction as,
Jenner, Edward, 15 54–58
education availability as, 61–62
k environmental sustainability as,
Khadgi, Deepak and Rosy, 71 62–63
Koch, Robert, 27 gender equality promotion as, 62
Kondé, Kader, 19 global partnership as, 63–64
maternal health improvement
l as, 58–60
Le Galès-Camus, Catherine, 86 overview of, 51–53
League of Nations, 28–29 poverty, hunger reduction as,
leprosy, 44 60–61
Lister, Joseph, 27 progress towards, 64–65, 113
Luís Figo and the World Tubercu- Monnet, Jean, 36–37
losis Cup, 79 mosquitoes, 74–75. See also
Lye, Serigne Dame, 55 Malaria
motorcycles, 96
m Mozambique, 58–59
Mahler, Halfdan, 32 Mpanju, Winnie, 20
Making Pregnancy Safer Initiative, Myanmar, 108
59–60 Mycobacterium tuberculosis, 77
malaria
affordability of drugs for, 63–64 n
child mortality and, 54–57 natural disasters, 106, 107–110
donations and, 49 Neglected Tropical Diseases
early work of WHO and, 31 Department, 44–45
environment and, 55 Nnamusoke, Miriame, 85–86
overview of, 73–77
Roll Back Malaria Partnership o
and, 48, 75–76 obesity, 88–91
Malaria Commission, 29 Office International d’Hygiène
malnutrition, 17, 45, 60–61 Publique (OIHP), 28–29
maternal health, 58–60
measles, 16, 54, 55, 56–57 p
medicines, affordable, 63–64 Pacific (Western), Regional Office
Mediterranean (Eastern), for, 42
Regional Office for, 42 Pan American Health Organiza-
mefloquin, 74 tion, 27–28, 31
Index 133
pandemics, 28 resolutions, overview of, 18

parasites, 73. See also Malaria respiratory disorders, 93–94. See
Pasteur, Louis, 27 also Asthma
PHEIC. See Public Health Emer- retroviruses, 66–67
gencies of International Concern Roll Back Malaria Partnership, 48,
plague, 98, 101 75–76
Plasmodium spp., 73. See also rural health centers, 32–33
Malaria
Plianbangchang, Samlee, 110 s
pneumonia, SARS and, 8 Safer Motherhood Initiative, 59
polio, 16, 99 Sahara Plus, 71
Poor Laws, 24 sanitation, 24–26, 62–63, 109,
poverty, 60–61, 113–115 110–111, 113–114
prevention SARS (severe acute respiratory
asthma, respiratory disorders syndrome), 8–11, 99, 106–107,
and, 93–94 115
body weight and, 88–91 SARS-CoV, 9
cancers and, 83–88 schistosomiasis, 44
cardiovascular diseases and, screening programs, cancers and,
82–83 85–86
of chronic diseases and injuries, secondhand smoke, 87
94–96 Secretariat, 40–41
diabetes and, 91–93 Serum Institute of India, 19
overview of, 81–82 severe acute respiratory syn-
primary health care systems, 47, drome. See SARS
49, 87 sexually transmitted diseases, 31.
Public Health Act, 25 See also HIV/AIDS
Public Health Emergencies of smallpox, 14–15, 49, 98, 99
International Concern (PHEIC), smoke, 55, 87
100–103 Sörensen, Eigil, 43
publications, 46–47, 72, 79 Southeast Asia, Regional Office
for, 42
q sovereignty, 44
quarantine, origins of practice, standardization, 47
23–25 Stop TB Department, 72, 78–79
Strategic Health Operations Cen-
r ter, 104–106
radiological accidents, 101 syphilis, 31
Red Cross, 33
regional offices, 42 t
regionalism, 48–49 teens, alcohol and, 37
relapsing fever, 98 T-helper lymphocytes, 67
Reproductive Health and tobacco use, 84–85, 87–88
Research Department, 72 trade, disease spread and, 22–26,
research, overview of, 46–47 45, 99–100
134 Index
traffic accidents, 95–96 travel and, 98, 100

transfusions, 67 Venice, 22–23
tsunamis, 106 viruses, 9, 66–67, 83. See also
tuberculosis, 31, 63, 67–68, 77–80 Specific viral diseases
typhoid, 28, 98
w
u West Nile fever, 101
ultraviolet radiation, 43 Western Pacific, Regional Office
UNAIDS, 69, 79 for, 42
UNICEF, 18, 33, 48, 54, 56 women’s rights. See Gender equal-
United Nations, 12–14, 18, 69–70, ity
104 World Bank, 33–34, 48, 52
United Nations Charter, 30 World Blood Donor Day, 48
Urbani, Carlo, 9–10 World Health Assembly, 17–18,
35–40
v World Health Day, 14
vaccinations, smallpox and, 15 World Health Report, 46–47
vaccines World Trade Organization, 52
affordable, 63–64 World War I, 28
child mortality and, 54–57 World War II, 12, 29
meningitis and, 18–19
programs for, 39 y
safety of, 45 yaws, 44–45
successes of, 16 yellow fever, 98
About the Contributors
G. S. Prentzas is the author of more than 20 books for young
readers. He is the author of Gideon v. Wainwright in Chelsea
House’s Great Supreme Court Decisions series and The
Brooklyn Bridge in Chelsea House’s Building America Then
and Now series. He has also written books on law, government,
geography, and history, covering such topics as the right to
counsel, criminal rights, Native American law, and the FBI.
Series editor Peggy Kahn is professor of political science at

the University of Michigan-Flint. She teaches courses in Euro-
pean politics, lived in England for many years, and has written
about British politics. She has been a social studies volunteer
in the Ann Arbor public schools. Her Ph.D. in political science
is from the University of California, Berkeley, and her B.A. in
history and government is from Oberlin College.
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GLOBAL

The World Health

The Arab League

The Association of Southeast Asian Nations

The Caribbean Community

The European Union

The International Atomic Energy Agency

The Organization of American States

The Organization of the Petroleum

The United Nations

The United Nations Children’s Fund

The World Bank and

The World Health Organization

The World Trade Organization

The World Health

Library of Congress Cataloging-in-Publication Data

Series design by Erik Lindstrom

This book is printed on acid-free paper.

2 The Rise of International Public Health 21

4 The UN Millennium Development Goals 51

6 Preventing and Controlling

7 Ensuring Global Health 97

8 Health Care for Everyone 112

that humans could sometimes contract flu viruses that afflict

the United States. In Canada, two Toronto hospitals had to turn

Urbani, a WHO doctor in Vietnam. He had examined Johnny

health can seemingly arise out of nowhere. In the past 25

SARS is a warning. SARS pushed even the most

international organization devoted to providing peace and

two fundamental ideas: that every nation has a duty to protect

One of the World Health Organization’s proudest achievements

Today, WHO has 193 member countries. Its membership

In 1798, British doctor Edward Jenner discovered that injecting

ties. Although the people who wrote WHO’s constitution could

Children in many poor families suffer from malnutrition,

WHO Works to Ensure Good Health

many resolutions. These resolutions deal with such matters as

cost of the vaccine to less than a dollar per injection, a price

• prevention of diseases through vaccines and immuni-

WHO plays a major role in helping people in all countries

Having worked with global and regional health orga-

Although cholera is no longer considered a major global health threat,

They observed that a disease would often spread from house to

in Europe. Because Europeans had not built up natural immu-

Trade and travel boomed as newfangled steamships and

English social reformer Edwin

by strengthening their quarantine laws. These tougher laws,

later, Chadwick headed a commission that studied sanitary condi-

To satisfy the demand for more raw materials for their

Early Twentieth-Century Organizations

would play an active role in the extensive campaign to eradicate

extend beyond OIHP’s existing role. The League of Nations

Representatives from 50 countries (later 51) convened in San Francisco to

from the world’s nations met in San Francisco in April 1945.

Council. The council agreed to organize an international health

less-developed countries. During the 1960s and 1970s, they

in developing countries. These new low-tech, locally appropri-

sources, enabling it to hire staff to develop national HIV/AIDS

WOrld HEaltH assEMBly

Representatives of other international and nongovernmental

The sixty-first session of the World Health Assembly adopted a reso-

encourage all nations to follow WHO directives. The assembly

The World Health Assembly was particularly concerned about

The assembly also approved a six-year plan to reduce the effects